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Principles of Applied Epistemology (APPLIED EPISTEMOLOGY)
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Mick Harper
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As Churchill said 'A lie can be half-way across the world before the truth has its boots on.'

We are not concerned with lies or fake news or anything of that sort. We are interested in forgeries only in so far as they are believed, if you see what I mean.

I have read that AEL is an attempt to challenge lazy thinking and received wisdom, which may be wrong.

When making such claims you should say where you have read such things. We do not 'attempt' though we mainly fall short, thinking should be fairly relaxed, wisdom can be received (especially when it's me that's laying it down), so you probably are wrong.

However, is it the case that we are at times positing contrarianism to orthodoxy rather than a genuine new heterodoxy?

I have problems with the following words from this sentence: we, at times, contrarianism, orthodoxy, genuine, new and heterodoxy. You should make yourself clearer.

I am genuinely interested to hear your views. Apologies if this has been covered elsewhere in the library, I have not stumbled across an answer in my random sampling.

We deprecate modesty in all its forms. A promising start though!
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Alfred Wegener


In: Newcastle upon Tyne
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Thanks Mick (I think),

I suppose that my question regarding my view on the 'challenge to received wisdom' was slightly ephemeral based on an overall perception of the posts I had read but looking back I found these quotes worth revisiting.



All of us AE supporters are instinctively bred to enjoy thinking contrary thoughts.



To do this it is necessary to re-train the brain. Even we cannot do without the dear little thing. Basically this means performing one simple, devastating and apparently impossible trick: whenever we have a familiar thought, a little burst of pain is delivered.



and
Applied Epistemology also says that you are only allowed to believe things that are unique to you
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Mick Harper
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Well, this is all a bit high level but the general notion is that the brain is designed not for thinking but for delivering conclusions. This is best done by acquiring data as efficiently as possible and then accessing and integrating that data as efficiently as possible. Which is all best done 'from authority'. Basically you take your mum's word for it.

This is fine and serves 99% of people well 99% of the time. Including, and this is what a lot of would-be Applied Epistemologists get wrong, ourselves. You have to rely on authority for the data and, mostly, rely on authority to integrate that data as well. Ninety-nine per cent of the time we come to the same conclusions as everybody else. What marks us out is the possession of techniques that indicate when the 'mostly' bit is not to be relied on.

The next big problem is that everybody thinks they have this facility. You won't find a human being alive who says, "I can't think for myself when I want to" and decides all on his Jack Jones to drink the Kool Aid. It turns out that what they mean is that they have espoused a minority orthodoxy on something or other. That is the origin of our most famous statement and the one that drew your attention

Applied Epistemology also says that you are only allowed to believe things that are unique to you

Contrarians are ten a penny. In fact they cluster in penny packets. Often to such an extent they become a ruling orthodoxy while still believing they are contrarians! Ask any kid on a green march and they will assure you that they are rebelling against the big, bad world. Ask the kid why his whole school is marching alongside and you'll get a look of sheer hatred.

Now start thinking about homeopathy and come up with something original. Not a conclusion at this stage, you've already come up with that.
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Wile E. Coyote


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Good Luck Alfredo

BTW In the quest for interesting ideas, random sampling never works for me.

You need one god. Cherish them. They are TRUTH. They are the way, follow them unquestioningly. Let them baptise you, indoctrinate you. It doesn't matter there is more than one god as you will reject them like all others, because within you is that nagging feeling they are not answering that most important of questions. They are in fact mysteriously set in their ways. You have rejected your god. You are the new GOD>>>> Others will now follow you.

Or more likely others will regard you as interesting but a bit bonkers.
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Mick Harper
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You're quite wrong there, Wiley. 'Others' will think you stupid and bonkers. Nobody has ever shown the slightest interest in our work. Unless you mean we will show interest. Yes, that's probably the most sensible ambition at this stage.
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Alfred Wegener


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As suggested, I hope that this does not impact the grandmother:egg interface.

Medicine is now practised along evidence based lines. The hierarchy of evidence is a construct with randomized controlled trials (RCTs) at the top (best possible evidence) and individual case studies at the bottom.

There are surely gaps where evidence is lacking and we then rely on 'best practice'. For example, it is best practice to examine the patient in order to inform the diagnosis, but no ethics committee in the world would approve a trial to investigate this process as it is received wisdom which has become somewhat unarguable.

If the evidence from RCTs combined into meta-analysis is overwhelming then the practice of medicine changes accordingly (sometimes slower than it should, but that is another argument.)

Homeopathy has been subject to many RCTs and these have been regularly incorporated into meta-analyses. The conclusion from all these trials is that 'it does not work'. It is not that it might not work, or that it is in some ways ambiguous; no it simply does not work - at all, in any way shape or form.

In many ways this is no surprise, as there are no active ingredients in homeopathic nostrums. None. It is therefore not biologically plausible to impute any possible benefit from such nostrums.

So why do people persist? Well, there is a market for people for whom medicine is not able to 'fix' their specific problem. People with incurable or intractable diseases. People who are well but worried about their general level of health. And, people who for whatever reason do not accept the medical model of disease.

For all these people homeopathy, or flower remedies or having their chakras realigned may be the closest they get to therapy.

That is not to say that these 'alternatives' do not make people feel better. Spending an hour with someone who listens kindly, is empathetic, sympathetic, puts a cold compress on your forehead, plays soothing music, gives you a cup of camomile tea and makes you the centre of their world is likely to make some people feel better.

However, this cognitive and neuronal positivity and general milieu is not a direct result of imbibing 'water with a memory' it is a construct based on ritual and expectation that 'this is medicine' and 'this will work'.

The placebo effect writ large, in other words.
By all means keep taking the waters, but please don't think that your personal experience is proof positive that homeopathy works.

As my children would say when they ask a question of me 'can we have the short answer rather than the long answer. This was the long answer, the short answer still stands, homeopathy is bunk.
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Mick Harper
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The first thing to say, Alphonse, is I just don’t want to read this because it looks boring. I’m always going on about this (to everyone, not just you) but presentation is vital since we are always dealing with things the brain doesn't really want to deal with. You have presented twelve two line paragraphs. So my brain is already saying, “Oh dear, twelve different things to grapple with, none of which are going to be fully explained to me.” Not a good start. But, dutifully, I did start reading

As suggested, I hope that this does not impact the grandmother:egg interface.

What have I just told you about modesty? Never mind opacity. I will try to continue after a lie down.
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Mick Harper
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Medicine is now practised along evidence based lines. The hierarchy of evidence is a construct with randomized controlled trials (RCTs) at the top (best possible evidence) and individual case studies at the bottom.

This is complete horse manure. Medicine has always been practised along evidence based lines. Do you suppose doctors waltz into the room and say, "I'm going to bleed you now because over the years we have found it doesn't work but what the hell"? But OK randomised controlled trials are relatively new. You're in the biz, what proportion of treatments are really being dished out because of RCT's? Not nearly as many as we think, would be my answer. And, as I'm sure you are aware, RCT's are not all they're cracked up to be either. Not that I'm knocking them, a very great advance.

I just don't know what 'individual case studies' are when they're at home. But I'll take your word they're at the bottom of the heap. Nasty little things.
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Alfred Wegener


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I don't think that you are quite on the money there Mick. Doctors stumbled into EBM (evidence based medicine) in the 1980s.

Before that there it was much more eminence based. In other words I am a professor and I am telling you what works.

Now we say, show me the evidence that this statin is better than that statin.

Individual case studies are reports by one doctor about one patient. Interesting reading for us medical types but repeat after me 'the plural of anecdote is not data.'

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Alfred Wegener


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As for your question about the proportion of medicines being 'dished out because of RCTs?'

It is a tricky one to answer as we cannot peer into every single consultation and record the decisions being made. However, I can tell you that there is huge variability in practice.

A start has been made to rationalize our approach, certainly in the UK.
This online resource provides digestible clinical evidence for doctors and other clinicians. [url https://cks.nice.org.uk/#?char=A]

Where there are gaps we tell people and where a recommendation is based on science we point to the science.

Where there is definitive evidence of harm or charlatanism we also point this out.

Progress eh? What's not to like?
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Mick Harper
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One of our Real Biggies is "What is, is what was". The basic reason for this is as a corrective to human beings' compulsion to believe that we are somehow better than people in the past. Or even different from people in the past.

Doctors stumbled into EBM (evidence based medicine) in the 1980s. Before that there it was much more eminence based. In other words I am a professor and I am telling you what works.

If you believe that doctors pre-1980 were more beholden to authority than post-1990 doctors then you will certainly be able to tell us what event or events happened in the 1980's to effect this truly momentous and unparalleled change. Do not, under any circumstances, consult somebody who received his (or her) own medical training in or around the 1980's as they will believe this piffle as an article of faith.
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Mick Harper
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I asked for something original, Alfalfa, not a restatement of your (and orthodoxy's and my and probably everybody here's) view of homeopathy and the status of science-based medicine. Nevertheless I will pick out the more toothsome chestnuts

There are surely gaps where evidence is lacking and we then rely on 'best practice'. For example, it is best practice to examine the patient in order to inform the diagnosis, but no ethics committee in the world would approve a trial to investigate this process as it is received wisdom which has become somewhat unarguable.

I found this fascinating and way beyond my radicalism -- medicine is not much my bag. I do not accept the ethics committee bit, it just wouldn't get that far! That's one of our beefs: they know not what they assume.

For all these people homeopathy, or flower remedies or having their chakras realigned may be the closest they get to therapy.

It is dangerous to make lists of one thing (treatments that people regard as alternative) and declare them to be another thing (therapy) or yet another thing (worthless as medical treatments). Academics are rather fond of this technique.

That is not to say that these 'alternatives' do not make people feel better

Measuring the difference between feeling better and being made better is not something either human beings or human societies have been good at traditionally. Pain, for example, is a particularly tricky concept. But 'depression' is the real tough nut.

Now we say, show me the evidence that this statin is better than that statin.

Have we then passed the stage of statin or not-to-statin? This is a genuine enquiry as I have to make a decision myself.
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Alfred Wegener


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My view of the medical orthodoxy is as you say in part a restatement. It is however based on the scientific paradigm and accurate insofar as medicine has progressed.

You did also ask for originality, is this to be valued over accuracy and truth?

I disagree about depression being a tough nut, there are well proven treatments for depression, which are very successful. Sometimes it is more of a challenge to expect people to recognise that they have depression or perhaps need psychological help.

Pain can be more problematic - especially neurological pain, that is very difficult to ameliorate.

As for statins, the evidence is now in and can of benefit for some people at high risk of cardiovascular disease. The question is 'are you at risk'? Usually defined as 15% of a cardiovascular event over 5 years or above.

Sometimes we also present the figures as numbers needed to treat (NNT) and numbers needed to harm (NNH).

Worth looking at your individual risk and the population statistics and making a judgement.

All this and free medical advice.
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Mick Harper
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My view of the medical orthodoxy is as you say in part a restatement.

Which part wasn't?

It is however based on the scientific paradigm and accurate insofar as medicine has progressed.

I'm sure it is. Why would we want to know that a doctor believes what he was taught at medical school, especially as it is what we ourselves believe?

You did also ask for originality, is this to be valued over accuracy and truth?

Absolutely. The truth is everywhere. I am not saying there are not times when simple statements of opinion (or indeed fact) are not germane to a particular discussion, it's just you introduced this topic so we had reasonable expectations of something original.

I disagree about depression being a tough nut, there are well proven treatments for depression, which are very successful. Sometimes it is more of a challenge to expect people to recognise that they have depression or perhaps need psychological help.

Good, good.

Pain can be more problematic - especially neurological pain, that is very difficult to ameliorate
.
Good, good.

As for statins, the evidence is now in and can of benefit for some people at high risk of cardiovascular disease. The question is 'are you at risk'? Usually defined as 15% of a cardiovascular event over 5 years or above.

Good, good.

Sometimes we also present the figures as numbers needed to treat (NNT) and numbers needed to harm (NNH).

I expect so.

Worth looking at your individual risk and the population statistics and making a judgement.

I doubt that you do.

All this and free medical advice.

Always glad to help. As you say, there's no charge though you might buy one of my books.
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Alfred Wegener


In: Newcastle upon Tyne
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An interesting recommendation - I have now bought both.
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