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Perhaps We Don’t Know Crap…
Rudolf Virchow is one of my few heroes. He was born in what is now Poland in 1821, and died 80 years later after a remarkable career in medicine (which he chose, because he viewed his voice as too weak to be a pastor). He was the first to describe such diseases as leukemia, embolism, spina bifida, and many others. He was one of the few academics of his era who was openly critical of Charles Darwin and the resulting eugenics, describing Darwin as an “ignoramus.” Lacking modern scientific techniques of electrophoresis and isoelectric focusing, he pioneered modern techniques of autopsy. He is widely credited with making the science of medicine less wizardly and more scientific. He was always a step ahead of his colleagues, regardless of the consequences of his outspoken criticisms of his contemporaries. He was widely criticized in his day, although many of his theories have proven to be more valid as we learn more about biochemistry, genetics, and so on.
In 1856 Dr. Virchow said, “Inflammation is the cause of atherosclerosis”. How he figured this out with the tools he had available, I’m not sure. But there is significant evidence available today that suggests that he might be right. The “pleotrophic benefits” of statins refer to their ability to reduce risk of heart attack even in those in whom they don’t change their cholesterol numbers. Statins are potent anti-inflammatories. Is that how they work? Maybe. Maybe Dr. Virchow had a point. We’re still not sure. So now, after more than 150 years, we have a name for his description of atherosclerotic disease, if not an understanding.
There are a few hundred different coronaviruses out there. Why is COVID-19 so deadly? I’m not sure. Why is the delta variant so problematic? I’m not sure. How did Virchow figure out what inflammation is? I’m not sure. But I know this: We don’t know crap. About crap. And I’ve decided that Dr. Virchow knew a lot of crap. About crap. Perhaps I could teach him a few things, given my understanding of modern science. Or perhaps I couldn’t. Perhaps I should temper my modern arrogance. Or perhaps I shouldn’t. I’m not sure.
Why do some of my patients die of pneumonia, while others get a sinus infection? I’m not sure. Why do some people have a stroke with a BP of 135/84, while others smoke cigarettes and die of old age at 102? I’m not sure. Why did my mother die young of some random cancer while complete losers live to be 100 despite years of self-abuse? I’m not sure.
Although I’m not sure it matters. I went into medicine hoping to understand all this stuff. And the better I get at my job, the more it’s clear that I don’t know crap about crap. So I read more Virchow. And I drink bourbon.
It helps. I guess. Although I suspect Dr. Virchow is chuckling somewhere. I suppose. I’m not sure.
Dr. Virchow said, “Medicine is a social science, and politics is nothing else but medicine on a large scale.” I have often wondered why leftists try so hard to gain governmental control of medicine. Perhaps Virchow understood. Perhaps he understood a lot. I’m not sure.
The more I study any field, the more it becomes obvious that I don’t understand. The less I know about any field, the more arrogant I become in my conclusions about that field. This seems odd to me. Although not, perhaps, to Dr. Virchow.
I have my own opinions about masks, vaccines, statins, ACE inhibitors, aspirin, infectious disease, leukemias, organ transplants, auto-immune diseases, bipolar disease, atherosclerotic disease, aneurysms, valvular disease, chronic sinusitis, and so on and so forth. And I’m sure I’m right. I presume that doctors 200 years from now will be referring to me as an accepted source, even long after I’m gone.
But perhaps they won’t.
Perhaps I lack the insight of a primitive doctor born well before my time. Or perhaps not. I’m not sure.
I am forced to decide. On each patient that walks into my office. I do the very best I can. And surely I’m right.
Right?
As we’re faced with difficult decisions, perhaps we would be well-advised to maintain a certain degree of humility. A degree of humility that does not come naturally to people in general. And not to politicians. And certainly not to doctors, specifically.
We do the best we can. And we hope that others do the best they can. And we hope that we all learn from the process.
Arrogance is not necessarily wrong. But lack of humility is wrong. Or, at least, it is dangerous.
Dr. Virchow understood this. He viewed strong centralized power structures as inherently dangerous: “Medicine is a social science, and politics is nothing else but medicine on a large scale.”
We do the best we can. But we must remain perpetually vigilant to the limits of our own hubris.
Politicians, and doctors, and humans in general – we struggle with such things.
But we keep trying. Those who came before us lacked our perspective, and our virtue. So we know better, right?
Right.
Unless we don’t know crap. About crap.
That is a possibility which we ought to consider.
Perhaps limited government makes sense. Perhaps we should seek to reduce the impact of harmful thinking by reducing the power of our government to enforce compliance to current theories. Whatever they are. Perhaps it is the amplification of bad ideas that is more dangerous than the bad ideas themselves. Perhaps we should worship modesty more than arrogance. Perhaps we should respect the ideas of others as much as we respect ourselves. Perhaps we should remember that we may not be as smart as we think we are.
Just perhaps…
Published in General
And yet that is a statement of exact knowledge isn’t it, or at least claims to be? “I never know exactly what time it is.” The fact that you never know exactly what time it is, is a statement of exact knowledge. Unless sometimes you actually do know exactly what time it is.
I’m not trying to be clever. You are making perfectly valid statements about empirical knowledge that I agree with. My point is that “knowledge about knowledge” is a form of knowledge, and can itself be exact. That science involves empirical claims that are always subject to revision is true, but the fact that science is a body of knowledge subject to empirical revision is not itself an empirical claim subject to revision. It is a “meta” claim about the nature of science itself and is certain in a way that science itself can’t be.
As a layman, I found Dr Malcolm Kendrick’s 65-part blog series on an inflammation origin theory of heart disease absolutely fascinating and convincing. Here’s a link to the first post:
https://drmalcolmkendrick.org/2016/01/18/what-causes-heart-disease/
I never know exactly what time it is, but I may be right at times and not know it. And as you have just proven, even exact statements that appear to be true, can be off by a bit.
And yet — I’ve never liked the expression: The exception proves the rule. No, it nullifies the rule. (In fact it refers to or identifies a false rule.) On the other hand, the exception proving the rule, gives me a lot of intellectual lee way so I shouldn’t object. I don’t have to be exactly correct to be pretty darned close.
What I really object to is people saying given A, and the relation between A and B, then C. But A is usually never fully correct, the relationship between A and B is not fully known, and because of this C is erroneous. But people seem to think that thinking logically leads to correct conclusions, and the oversimplify it into full error.
Thanks, I’ve saved it.
It’s like rounding numbers before operating on them instead of rounding the resulting number…
Truncating bothers me, but I’m not compulsive about it or anything. But I always do check out a new calculator.
/raises hand enthusiastically
Oo, oo, I “know!” Leftism is all about control and power. It is a totalizing ideology, because, you see, leftists are just so darned smart and good! Just ask them.
Reminds one of that promise of the Serpent, “You will be as gods.” People make terrible gods (literally causing terror — see Afghanistan today). That’s something both Judaism and Christianity taught and which has been unlearned by the secular West.
So, I think I understand why leftists grasp at power. What confounds me is why any marginally intelligent, experienced adult wants to give it to them at the ballot box — Biden/Harris 2020, for example.
I work with financial numbers in programming and this is always a problem for me when creating a new function. Do I round to pennies during all the operations or only at display? The results can vary wildly. So I have limited myself to display rounding only.
Dont know any medicine. Sitting in surgery room waiting. Agree with every thing you say. It took me years to realize how little we know about most things, but I knew more about our limits sooner than most of my professional colleagues. Maybe they were pretending as well. In any event Ive been at close to the top and worked with incredibly brilliant folks, IQ probably not measurable. So the idea that people by themselves or in well selected committees could run this country, even if-not self interested, is simply not credible. Bottom up works if we set it up right with the right people and are very lucky and have time. We were and had time. Don’t know now, but top down cant work well for long let alone with demented crooked clowns.
@drbastiat Exactly one second before starting to read your post I clicked “Publish” on a post that is surprisingly related. It contains these similar observations:
We don’t know crap.
R, I look forward to that conversation.
Better to be approximately correct than precisely wrong.
Yeah, that’s the best way to phrase it.
Well, it’s close :-)
The most important three words in the English language may be “I don’t know.”
To this layman medicine is as much of an art as it is a science. If I drop a hammer out of my hand I know 100% of the time it will fall to the ground. If I were to administer a medication, no matter how well studied, I could cure someone or kill them.
That’s what people do not appreciate about vaccine hesitancy. I don’t care how much “certainty” the government insists they have in the safety of these things, I’ve seen their act before. I’ve seen how many approvals have been rescinded because problems cropped up years down the line. They don’t know.
To this day, gravoty remains only a theory because we cannot yet idenfity the mechanism to the level of detail that we would like. What we call gravity obviously happens, but we don’t really “get it” other than statistically valid observations and predictions.
There’s a lot of nuance about knowing, and much of the rotten ice is not worth walking across.
It is easy to dismiss the just-so pronouncements of geneticists or plate tectonic people when they talk about what happened nine crapzillion years ago, saying “well how would you know?” and then most of us are unwilling to sit around for the answer. Just the same it is all too easy for those who do know these things — to the degree that they are known at all — to make the tiny leap from 99.9999999 to 100 and instead of filtering for reasoned criticism, to just stop listening to any criticism. It is a human reaction. At least I’m 99.999999999% confident that it is.
I’m learning about making precision measurements in my new job. You know when we know our measurement is BS? When the window of precision is zero percent (100% accuracy) or in the E-14 or E-15 range. As my boss says, “we’re not that good.”
Someone should explain it to lefties. Unfortunately, like Barbie, they find math (and reality) hard to grasp.
This was not an issue when we used slide rules. Judgement was essential.
And close is pretty darn near the best you can get. Well done. :)
Slide rules are analog. Analog requires judgment.
Prayers to our fallen soldiers today and those that may be left behind.
This is my first comment on Ricochet. I just joined a couple hours ago. Before even reading this post I had to come up with a name. I stared at that screen a long time. No lie, the cat jumped up and picked jjjjerrjj for me. I picked Chowderhead instead. I did have to look it up to see if the meaning changed over the years. Yes, it got softer. When I was a kid it meant you were kind of an airhead or a dope.
There is a reason why our children are so much smarter than us while in high school. They have mastered 100% of the information they are presented with, according to them. As I have gotten older each time I learn something new it opens a door to two other things I realize I don’t know. So, the more I learn the more I realize I don’t know crap.
I think an experienced doctor that doesn’t know crap would be way better than a new doctor out of med school that knows everything.
Chowderhead
Welcome to Ricochet, Chowderhead. Sad day to join, but you’ll probably never forget your anniversary date.
Welcome, Chowderhead.
[Insert clever remark about Dominion machine counting methods here.]
Vote against established Republican politicians in the primaries; vote against Democrats in the general.
Philosophers talk about whether we really know that A LOT.
I got YouTubes, people!
But here’s a nice Ricochet post introducing the topic.
Welcome!
Chowderhead is good. jjjjerrjj would have been good too.
Well, then, I’m the doctor for you!
Welcome, Chowderhead! It’s great to have you aboard!
Welcome, Chowderhead!