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Tuesday, June 26, 2018

On "belief" and clinical cognition

"Our brains and nervous systems constitute a belief-generating machine, a system that evolved to assure not truth, logic, and reason, but survival."
-- James Alcock, 1995
Ran into a great book review over at Science Based Medicine today, a new release "How We Believe."

The power of belief
Beliefs guide all our thoughts and behaviors, from brushing our teeth to voting for a particular political party. They have power over life and death: people have willingly died for their beliefs, and someone commits suicide every forty seconds. Alcock elucidates the various factors that contribute to suicide terrorism. And he tries to explain why some beliefs are so powerful that they are impervious to reason and evidence. [emphasis mine - BG]

The belief engine
Alcock says there is nothing fundamentally different about the nature of beliefs that we consider rational and those we deem irrational. We do not choose our beliefs; they are generated and maintained through automatic processes in our brains. He explains what goes into those automatic processes: perceiving, remembering, learning, feeling, and thinking. And he shows how those processes can depart from reality…

Belief and well-being

There can be illness (subjective symptoms) without disease (pathophysiology). Beliefs about the state of our health may not reflect the actual state of health but can contribute to it. Is stress harmful? The belief that stress is bad for us can be deleterious to our health. Alcock examines possibly unreliable reports of people scared to death, dying after hexes, the “broken heart” syndrome, etc. He discusses hysteria, mass hysteria, hypochondria, the worried well, and questionable diagnoses like multiple chemical sensitivity and electromagnetic hypersensitivity.

Belief and healing
Feeling better after a treatment doesn’t necessarily mean we actually are better. Suggestion is powerful, healing rituals are persuasive. He covers Mesmer’s “animal magnetism,” placebo effects, sham surgeries, learned responses, expectancy effects, conditioning, social learning, and theological placebos. He says there are three types of healing: natural healing (the body heals itself), technological healing (drugs, surgery) and interpersonal healing that depends on context and personal interactions and that leads to improvements in illness but not in disease...
Great. Just what I need, yet another book in the Kindle stash. Downloaded.

apropos, a few of my prior posts, "Clinical cognition in the digital age," "Kahneman and Teverksy: clinical judgment and decisionmaking," and "Just the facts..."

Another read I have in progress that will be triangulation grist for this topic.

"Doctors use reason and probability to assess and treat patients. But given the complexity, uncertainty, and fast pace of real-world medical practice, physicians have no choice but to use mental shortcuts and probability estimates as they do their vital work. When doctors deeply understand how they reason, they improve their clinical decision making. This book teaches students, residents, and practicing physicians to think clearly about the logic, probability, and cognitive psychology of medical reasoning. Simple examples, visual explanations, and historical context make the art of how doctors think fascinating and highly relevant to daily medical practice. Reading this book will help you improve the care of your patients, one at a time."
See also my prior post "Clinical workflow, clinical cognition and the Distracted Mind."

Thinking broadly about the core initiating topic for this blog, I remain acutely interested in the myriad factors that guide (and both facilitate or hamper) clinical cognition, including the impacts of DigiTech., e.g., "Are structured data the enemy of health care quality?" 

UPDATE

Interesting post over on Medium:
We’re In an Epidemic of Mistrust in Science
Academia isn’t immune to the scourge of misinformation


Dozens of infants and children in Romania died recently in a major measles outbreak, as a result of prominent celebrities campaigning against vaccination. This trend parallels that of Europe as a whole, which suffered a 400 percent increase in measles cases from 2016 to 2017. Unvaccinated Americans traveling to the World Cup may well bring back the disease to the United States.

Of course, we don’t need European travel to suffer from measles. Kansas just experienced its worst measles outbreak in decades. Children and adults in a few unvaccinated families were key to this widespread outbreak.

Just like in Romania, parents in the United States are fooled by the false claim that vaccines cause autism. This belief has spread widely across the country and leads to a host of problems.

Measles was practically eliminated in the United States by 2000. In recent years, however, outbreaks of measles have been on the rise, driven by parents failing to vaccinate their children in a number of communities. We should be especially concerned because our president has frequently expressed the false view that vaccines cause autism, and his administration has pushed against funding “science-based” policies at the Centers for Disease Control and Prevention.

These illnesses and deaths are among many terrible consequences of the crisis of trust suffered by our institutions in recent years. While headlines focus on declining trust in the media and government, science and academia are not immune to this crisis of confidence, and the results can be deadly…
See my prior "War on Science" related posts.


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More to come...

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