# Searching for Problems and Ignoring Solutions

I took statistics in college, and we studied it in medical school, but for some reason it didn’t really affect me.  Then, later in my career, I gradually came to the realization that many of the decisions I was making for my patients were based on guesswork.  Educated guesswork.  But still, I was mostly guessing.  That is a terrifying realization for a physician to make.  Although in my view, it’s more terrifying when a physician doesn’t realize it.

Anyway, at that point, I started studying statistics in earnest.  I’m good at math, and had always excelled at calculus and so on in school.  But I slowly reached the conclusion that statistics isn’t really math.  At least, not in my view.  It’s a way of looking at the world.  In fact, the world doesn’t make much sense, until you understand statistics.  At that point, things become a little clearer (or, perhaps, a bit less unclear), and decision making becomes simpler.  Again – the use of statistics does not make things more complex.  It makes things simpler.

I’ve given hundreds of speeches to doctors’ groups all over the country (mostly about heart disease), and I spend a lot of time on statistics.  The number one complaint I get on my reviews is, “I’m not a mathematician!  I’m a doctor!  Talk about medicine, not math!”  I respond simply that medicine is complex, and it’s virtually impossible to understand if you don’t understand statistics.  Math is simply the language we use to precisely describe complicated things.  I teach about math, because I don’t know how else to explain how heart disease works.  But after having explained my point to countless doctors, and countless patients, I’ve noticed a few trends about how people look at complex problems.  Perhaps you’ll recognize these trends, based on your experiences:

I think that in general, most doctors order way too many tests.  They don’t necessarily understand exactly how those tests are done, or what they measure exactly, or what to do with the results.  But if they think someone has heart disease, they just start checking every box on the “Cardiovascular” panel.  I explained part of my concern about this in a previous post:

A couple years ago I was giving a lecture to a group of Cardiologists about advanced cardiovascular testing, and someone asked if I used a certain lab test.  I answered, no, that I found it unhelpful.  He protested that it was an accurate test.  I agreed, but replied, “To me, it’s like an Obama sticker on a Prius.  It may be accurate, but it doesn’t add any information that you didn’t already know.”

So I spend a lot of time trying to get doctors to think backwards, sort of.  What can be done if the person has this disease?  What tests will help you determine your course of action?  What tests are unhelpful, and therefore potentially misleading?  This is a big, complicated topic well beyond the scope of this post.  But my point is that lots of very intelligent physicians struggle with relatively straightforward data analysis.  And they do this for a living.

Imagine those with no background in math.

I’ve noticed that a patient’s inclination to treat a disease is often inversely proportional to their inclination to collect data about that disease.  And I think that perhaps that dichotomy might help explain many of our social problems today.  Let me try to explain.  See if you agree with my premise…

“Susan” had dinner at her club last month with a patient of mine, who happens to be a retired cardiovascular surgeon.  He went on at some length about how impressed he was with my efforts to approach heart disease in a rational, evidence-based manner.

Susan is very fit and focused on her health, because everybody in her family dies young of heart disease.  Her total cholesterol is always over 300 despite her best efforts.  She refuses to take statins or other ‘cholesterol drugs,’ but understands that she has a problem.  She was so impressed by what her friend said that she paid her money and joined my practice.  Our first visit was fascinating:

Susan:  “I really look forward to working with you.  Dr. Smith said you’re really good at heart disease.”

Me:  “Thanks!  I do the best I can.  How can I help you?”

Susan:  “I have really high cholesterol and a lousy family history.  But I don’t want to put a bunch of chemicals in my body, and all my previous physicians have tried to put me on a bunch of drugs.  I’ll be interested to hear your advice.”

Me:  “Sure.  Do you have any of your previous labs?”

Susan:  “Here’s the last set of labs from my previous doc.”
* hands me a big stack of papers *

Me:  * starts paging through every lab test I’ve ever heard of, and some that I hadn’t… *
“Wow.”

Susan:  “Wow?  What do you mean?”

I’m not sure what to say here.  Either her previous physician had no idea what she was doing, or she was trying to show off by ordering lots of exotic tests.  I suppose it doesn’t matter which one is true.  I’m trying not to step on toes, so I ask, “So, um, what did your previous doc say about all this?”

Susan:  “She tried to put me on a statin.  But I’ve read that statins are bad for you.”

Me:  “I can believe that.”

Susan:  “You believe that statins are bad for you?”

Me:  “No.  I can believe that you read that.”

Susan:  “What do you mean?”

Me:  “I mean that if your previous doc had read your family history, and had looked at these labs, and decided not to treat, that I would call that doctor on the phone and ask what on earth she was thinking.”

Susan:  “I don’t want to put a bunch of chemicals in my body.”

Me:  “Do you take any meds at all?”

Susan:  “No way.  Like I said, I don’t want to put a bunch of chemicals in my body.”

Me:  “Do you take any supplements?”

Not surprisingly, Susan pulled a Ziploc bag out of her purse, filled with every supplement I’ve ever heard of, and some that I hadn’t.  I said, “Wow – that’s a lot of chemicals that you’re putting into your body.”  I grab a bottle at random and show it to her.  “What does the research say about this one?”

Susan:  “What do you mean?”

Me:  “Do people who take it live longer?  Which people?  Are you one of those people?  How can we tell?”

Susan:  * starting to get understandably defensive *
“Look, can we just repeat these labs, and see what we find?”

Me:  “Not if we’re not going to treat it.  If you’ve decided not to treat your heart disease, that’s fine.  That’s your prerogative.  But if we’re considering treatment, I think we should check some basic stuff, look for root causes of disease, and decide on a rational course of action here.”

Susan:  “What about my SDMA?  What about all those other inflammation markers?”

Me:  “Those may prove to be relevant someday, but right now they’re very poorly understood.  Let’s work with what we know – what we have evidence to support.  We already have what we need.  Let’s develop a plan of attack, based on your particular situation.  Find the disease.  Fix the disease.  Move on with our lives.  Checking the same meaningless tests over and over again is unhelpful.  And if that’s your plan of action, then you don’t need me.”

Well, things went downhill from there.

She wanted to do more tests, but didn’t want to treat.  I wanted to treat, but didn’t want to do more tests.  The only reason the conversation went on as long as it did was that her husband was there, and didn’t want to walk away from potentially life-saving treatment.

I found it fascinating that she was so unwilling to consider treatments, but she was so insistent on doing more and more testing.  Why do all these tests to find a problem that you have no interest in fixing?

Consider the global warming crowd.  They want more and more computer models.  Is the earth warming by 1.7 degrees?  Or is it 1.9 degrees?  Let’s do more studies!

Well, ok.  But if fossil fuels are dangerous, perhaps we might consider nuclear power, which results in only warm water and tiny amounts of nuclear waste which can be easily contained and managed.  Ok.  Let’s get to work.

No.  Let’s do more and more computer models.  Which we refuse to act on.

How many studies have been done on the problems of children of broken families, pipelines, welfare programs, ethanol fuel, virus mitigation strategies, immigration policies, and so on?  We keep doing more studies.  And more and more and more.

But it’s easier to study these things than to fix them.  So we search for problems that we fully intend to ignore.  This seems odd, but it is not unusual behavior.

Now, I understand, up to a point.  Our fears of statins, nuclear power, intact families, and so on prevent us from considering rational treatments, so we do more studies.  Got to spend that grant money somehow, right?  And maybe we might find a more palatable solution.  Maybe.

But what if we don’t?

It seems to me that sometimes the more data someone wants, the less interested they are in fixing the problem they’re studying.  Or something.

One problem here is probably that in order to improve most of our social problems, our government would need to do less, and spend less, rather than more.  No politician can run for office on that, so they avoid exploring solutions (which might not work, which would look bad) and they spend more money on studies.

But I don’t think that’s it, entirely.  I think there may be a parallel between excessive government studies and my patients who want every test under the sun run on them, regardless of the evidence behind these tests, because they want to “do something” about a disease they have no interest in treating.

“Susan’s” approach to heart disease seems similar to Nancy Pelosi’s approach to homelessness.  And is similarly effective.

Perhaps this isn’t just political expediency – perhaps it’s human nature.

Or perhaps it’s not.

What do you think?

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1. Coolidge
Lawst N. Thawt
@LawstNThawt

Dr. Bastiat: One problem here is probably that in order to improve most of our social problems, our government would need to do less, and spend less, rather than more.

I’m almost convinced this is the sole purpose of modern government.  “Whatever this problem, is it something we can study because then we’ll be doing something to justify our existence.”

I think people in management positions do the same thing, whether it’s managing their own heart disease, their family, or their company.  They have no problem-solving skills, so they “do something” to feel better and justify their management.

We’re likely all guilty, at times, of doing something just so we can be doing something.

2. Thatcher
Percival
@Percival

Dr. Bastiat: Imagine those with no background in math.

Easy.

3. Member
Arahant
@Arahant

I suspect “Susan” would need statistics on statins, not that she’d necessarily understand them. And they probably wouldn’t change her mind. As for governments, they are the problem waiting for the solution to be found.

4. Member
Dr. Bastiat
@drbastiat

Arahant (View Comment):
I suspect “Susan” would need statistics on statins, not that she’d necessarily understand them. And they probably wouldn’t change her mind.

I gave her statistics on statins.  Lots of very compelling statistics.

And you’re right – it didn’t change her mind.

5. Member
Bob Thompson
@BobThompson

I like how you approach problems. One thing you might be able to clarify for me. I tend to want to separate those things that people ‘catch’ from their environment, from breathing or other contact, and those things that are genetic or result from specific individual behaviors. I think of the former as diseases (maybe that is a too limited label) and the latter as medical conditions. I have had two open heart surgeries needed because of calcification of my bi-modal aortic valve. As stated above, I never thought of this as heart disease but as a medical condition in need of attention.

6. Thatcher
Doug Kimball
@DougKimball

I illustrated the anti-math, anti-statistics bias in my novel, “Acadia”.  Here is the excerpt:

Levy’s controversial calling was first introduced when an excerpt of his doctoral thesis at Columbia was published in the nascent “Nature” journal and picked up by all of the news agencies as well as Newsweek and Time.  The title of the popular article, ‘Your Chihuahua is a Wolf,’ explains that according to Levy’s research, the genetic code of a Chihuahua varies by less than an estimated 0.3% from that of a wild Gray Wolf, and that this variation is smaller than the variation between an Aboriginal Australian and a typical American of any race.  Of course, the point of Levy’s paper is to illustrate revolutionary techniques for mapping and sequencing genetic material using advances in micro-optics, biochemistry, mathematics and complex population trait statistics.  These statistics were developed after the years of continued cross breeding of dogs with wolves and then following the occurrence of traits unique to each variant.  The science itself is lost on the editor from “Nature” who instead is intrigued by the obvious fact that a single species could produce such wide physical variation.  Among Levy’s colleagues, this popular media attention labels him a “junk” scientist.  This potent combination of ignorance, jealousy and envy eventually precluded Levy from receiving an offer of tenure at Columbia.

Levy remembers the precise moment of his rejection.  The Columbia Biology (which at the time included both Zoology and Botany) Department chair, Arnold Silverstein, a churlish little man, had called him in for “a special counseling meeting.”  Levy naively thought that this would be a cordial meeting, perhaps to discuss his new lab program for the pre-med undergraduate course requirement, Bio-5.  He was quite proud of this program, an extension of his other work which involved the study of drosophila – fruit flies.  They are cross-bred over several generations and statistics related to the occurrence of debilitating recessive traits allowed some rudimentary genetic modeling.  But Silverstein does not want to talk about fruit flies.  He asks Levy to sit in one of the low, upholstered chairs at a small round, marble-topped, table crowded next to the chairman’s immense cherry desk.  As soon as Levy is comfortably seated, Silverstein tosses a copy of ‘Nature’ on the table and asks, “What’s this?”

“It’s ‘Nature’,” Levy says, “a popular science journal.”

“Don’t get smart with me, Levy.  I mean, since when do Columbia scholars have their papers published in magazines like this?”

“I’m not sure I understand your question.  I didn’t publish anything in “Nature” per se.  They referred to my research in an article.  The article is loosely about my work, but it is not my work.”

“Referred to your research?  They referred to your research here at Columbia?”  Silverstein gets up from his chair and begins pacing.

Levy is nonplussed and tries to explain.  “As it was described to me, ‘Nature’ is a new kind of journal.  The editors want to support serious scholarship, but they also want to make science as accessible as possible to the public.  They want to be to the natural sciences what ‘Architectural Digest’ is to architecture.”

“A serious scientific journal does not publish ‘Your Chihuahua is a Wolf’.”  Silverstein stops and turns his head to avoid Levy’s attempt at eye contact.

“I didn’t pick the title.  I guess ‘Nominal Statistical Genetic Diversity Among Indigenous North American Canines’ is not a title the editor felt would encourage readership.”  Levy remains proud that his research was the basis for an article in this slick new journal.

Silverstein starts to pace again and does not immediately react to Levy’s remark.  When he does react, he chooses to return the sarcasm.  “Why didn’t you just send the paper to ‘Popular Science’?   I’m sure some of the editors there like dogs.”

Levy does not know how to react, so picks up the journal.  He immediately notices that it is in perfect condition, right off the press, not a dog-ear, not a bend of a page, not a bit of evidence that it was ever opened.   Finally, in self-defense, he breaks the silence.  “Did you read the article?  Did you even look through the magazine?”

“I read serious scholarship, Mr. Levy.  I don’t have time for magazines.”  Silverstein squints at Levy, plants both hands firmly on the small table and pulls, looking even more rat-like than usual, closer to Levy.  “At Columbia in my Biology Department we don’t like to be embarrassed.  We take our science seriously.  Our relationship to our work is visceral – we dissect, we describe, we experiment, we explore.  The statisticians and mathematicians are over in Cable Hall in the Physics and Math departments.  That’s where they belong.  And we don’t publish our work in popular science magazines.  Do I make myself clear?”

7. Contributor
Henry Racette
@HenryRacette

I think “Susan’s” situation may differ from a lot of our big social problems in one unfortunate way.

Susan has problem P. She knows she has problem P. She really wants to solve problem P. You suggest solution A. Susan is convinced that solution B is the better route, despite your superior knowledge and expertise, and can’t be dissuaded. So she continues trying to solve problem P with ineffective solution B. Susan dies young, which is sad.

Contrast that with, say, the plight of young urban black males.

They have problem P. We know they have problem P. Sensible people know that solution A will directly address problem P. But activists and politicians suggest solution B, which will at best make the problem no worse but probably will, actually, make the problem worse. Dummies.

Or not really dummies, because the politicians and activists often aren’t trying to solve problem P. They’re using problem P as a justification for “solutions” B, C, and D, all of which they hope will bring about result X, which is a far more valuable outcome to them than solving problem P ever was.

In the 1960s, Daniel Moynihan saw the self-destruction of the black family as a problem to be fixed before it created the situation we are in today. The plight of young black American men is now a tool to be used to achieve other goals by BLM and similarly corrupt and self-serving institutions.

8. Thatcher
Doug Kimball
@DougKimball

I think “Susan’s” situation may differ from a lot of our big social problems in on unfortunate way.

Susan has problem P. She knows she has problem P. She really wants to solve problem P. You suggest solution A. Susan is convinced that solution B is the better route, despite your superior knowledge and expertise, and can’t be dissuaded. So she continues trying to solve problem P with ineffective solution B. Susan dies young, which is sad.

Contrast that with, say, the plight of young urban black males.

They have problem P. We know they have problem P. Sensible people know that solution A will directly address problem P. But activists and politicians suggest solution B, which will at best make the problem no worse but probably will, actually, make the problem worse. Dummies.

Or not really dummies, because the politicians and activists often aren’t trying to solve problem P. They’re using problem P as a justification for “solutions” B, C, and D, all of which they hope will bring about result X, which is a far more valuable outcome to them than solving problem P ever was.

In the 1960s, Daniel Moynihan saw the self-destruction of the black family as a problem to be fixed before it created the situation we are in today. The plight of young black American men is now a tool to be used to achieve other goals by BLM and similarly corrupt and self-serving institutions.

Never let a crisis go to waste!  (Even those you helped create.)

9. Member
Jim McConnell
@JimMcConnell

I like how you approach problems. One thing you might be able to clarify for me. I tend to want to separate those things that people ‘catch’ from their environment, from breathing or other contact, and those things that are genetic or result from specific individual behaviors. I think of the former as diseases (maybe that is a too limited label) and the latter as medical conditions. I have had two open heart surgeries needed because of calcification of my bi-modal aortic valve. As stated above, I never thought of this as heart disease but as a medical condition in need of attention.

My thoughts exactly. I’ve had “heart disease” since 1987, but it is not a disease; it’s a structural problem of my heart. But, by definition, it is heart disease.

10. Coolidge
Gossamer Cat
@GossamerCat

I have had excellent vets over the past 20 years and one of the things I appreciate most is that they don’t recommend unnecessary tests.  An unnecessary test is defined as one that will have no impact on a decision to treat or a treatment regimen.  I don’t know if it easier for vets to take this approach because their clients don’t have a say and the owners are usually footing the full cost of the bill.

I also know that hospitals make a lot of money from performing some tests.  Expensive machines have to be paid for.  In that case, I suspect it is math of a different kind driving that decision.

11. Member
Django
@Django

It seems to me that sometimes the more data someone wants, the less interested they are in fixing the problem they’re studying.  Or something.

Some people do “research”. I was involved in a proposal for a government contract that, had we won it, would have been worth billions over the long haul. The Chief Systems Engineer brought in a researcher and asked how we could apply the fruits of his years of work to this proposal. The guy just looked at us at first as though he didn’t understand the question, but eventually said, “This is research. You can’t expect that this is actually going to work.” Well, we did expect that it would work, and the scientist didn’t like it when it was pointed out that the expectation that it would work was exactly why his research had been funded for years. I guess he thought the purpose was to publish papers and go to meetings with his peers.

12. Member
Dr. Bastiat
@drbastiat

I like how you approach problems. One thing you might be able to clarify for me. I tend to want to separate those things that people ‘catch’ from their environment, from breathing or other contact, and those things that are genetic or result from specific individual behaviors. I think of the former as diseases (maybe that is a too limited label) and the latter as medical conditions. I have had two open heart surgeries needed because of calcification of my bi-modal aortic valve. As stated above, I never thought of this as heart disease but as a medical condition in need of attention.

There’s lots of kinds of heart disease.  Inherited structural problems.  Atherosclerotic vascular disease.  Valvular disease.  Heart failure (diastolic and systolic, which are very different from one another).  Rhythm problems – a. fib, pacemakers, and all that.  Various types of cardiomyopathy.  Pericarditis.  Septal defects.  And on and on.  They’re all very different conditions.

But they’re all heart disease.

13. Member
Z in MT
@ZinMT

I have had excellent vets over the past 20 years and one of the things I appreciate most is that they don’t recommend unnecessary tests. An unnecessary test is defined as one that will have no impact on a decision to treat or a treatment regimen. I don’t know if it easier for vets to take this approach because their clients don’t have a say and the owners are usually footing the full cost of the bill.

I also know that hospitals make a lot of money from performing some tests. Expensive machines have to be paid for. In that case, I suspect it is math of a different kind driving that decision.

Exactly. Since hospital’s medicare and insurance reimbursement is based on fee for service, test are easy revenue generators. They are obvious services and hard to dispute as unnecessary.

14. Member
Bob Thompson
@BobThompson

I also know that hospitals make a lot of money from performing some tests.  Expensive machines have to be paid for.  In that case, I suspect it is math of a different kind driving that decision.

Who thinks hospitals perform questionably necessary tests to compensate for those tests performed where there is no possible source to pay? With illegal immigrants being transported to various cities in the middle of the night, do we think these people, when they need medical care, are going to pay the bill? That care is needed but when done this way there is no accountability for how that care is getting accomplished.

15. Coolidge
Nohaaj
@Nohaaj

# Searching for problems and ignoring solutions

Susan didn’t want to avoid a solution.  She wanted a solution that fit her pre-conceived notion of how the solution should look.

People (governments, researchers, etal) who ask for grants and perform research have a preconceived notion of what they want the result to be.  It is considered a failure if their studies don’t prove their beliefs, hence, they must study it more, because if only they tweak another variable, surely the results will fit their preconceived beliefs.  Every climate change model is an example of this type of process, which gives us hockey stick doom projections that never occur.  But those researchers are lauded and given utmost respect  for their ground breaking research.

16. Member
Hang On
@HangOn

I suspect Susan is trying to put off a decision as an attempt (at least psychologically) to put off death. If you were a magical medicine man, you might have more success. At least with Susans.

17. Member
Full Size Tabby
@FullSizeTabby

When I was pushed into a corporate role managing certain law department processes I started receiving a bunch of reports (usually monthly) for which I kept asking, “What am I (or anyone else) supposed to change based on this information?” I discovered a lot of reports continued to be generated because once upon a time some specific decision needed to be made, for which the report was relevant. But the report took on a life of its own. Or the data in the report was relevant to making decisions in line with some previous objective or strategy, which objective or strategy was subsequently changed to render the data no longer relevant to decisions that needed to be made today in line with today’s objective or strategy. But every time I canceled some line of data collection and reporting I worried that there was someone who did rely on that data to make some decision I didn’t know about. Though by asking around before terminating a report I did learn a lot about the processes within the department I was supposed to be managing. I also had to convince a boss who was used to seeing those reports (even though he did nothing with the information in them) that those reports were no longer useful. He just took great comfort in seeing them pass every month.

18. Member
RufusRJones
@RufusRJones

Dr. Bastiat: One problem here is probably that in order to improve most of our social problems, our government would need to do less, and spend less, rather than more.

There is no value added from “non-public goods”.

There is no value added from the IRS and the tax code. It should be one flat tax and one deduction for procreating more tax slaves.

There is no value added from the Fed pushing the economy around. It should back up the financial system in a punitive way and leave it at that.

Theoretically, Medicare and Social Security are a good idea, but they aren’t even close to being run right. There is no good reason for any other government actuarial system.

None of this works, so we do more. Then the government runs out of money after crazy social problems.

19. Thatcher
Clavius
@Clavius

This reminds me of a story told by Moshe Rubenstein, the wonderful Professor Emeritus of problem solving at UCLA.

He was in Israel when his 85-year old father in law passed out in the orchard in the Kibbutz.  As the older male family member, he became the contact person with the hostpital.  The father in law was breathing fine, but was just out cold and would not wake up.  The doctor wanted to do a spinal tap to see if there was blood in the spinal fluid.  Moshe asked what would the doctor would do if he found blood.  The doctor responded that the normal thing to do would be to operate to stop the bleeding.  Moshe said, “What, you would do brain surgery on an 85-year old man?”  The doctor responded, “No, I guess that wouldn’t make sense.”

There was no spinal tap test.

Moshe was, as you are, pointing out that you do tests to guide your actions.  If they won’t guide your actions, don’t do the tests.

20. Member
Henry Castaigne
@HenryCastaigne

Dr. Bastiat: Our fears of statins, nuclear power, intact families, and so on prevent us from considering rational treatments, so we do more studies.

Soctt Yenor wrote about the fear of the nuclear family in The Recovery of Family Life and this podcast talks about Environmentalism. In both these works, there is a solution that people prefer because of spiritual or ideological reasons so extra knowledge is useless. I am thinking of the vaccines cause autism crowd and how much they read and how little it informs.

Susan thinks feels that statins are impure because they are made by Western medicine. Herbal supplements are aligned with purity and are therefore are good. Where she a Christian or a Buddhist (old school Buddhist not that hippy-dippy for white people nonsense) she would have a different locus of spirituality and purity so statins would be fine if the statistics suggested that they were effective and relatively safe. (I defer your expertise Dr. Bastiat. I assume that most of them work just fine but some have some side-effects to with some people.) You see without something like an organized religion, spirituality goes back into the body. This is why we are obsessed with food, vaccines and to the lesser extent transgenderism. The body is now the locus of worship.

Additionally, though this comes from observation and theory rather than empirical studies, the resentment of free markets and the downplaying of their constant success is likely also due to disgust money.

Religion/superstition > reason/empiricism to most of the human brain.

Dear Doctor, I am despairing Clearly only a few humans are capable of making reason their highest or second highest virtue. Even worse, they are incapable of doing it with regard to the physical universe. Even research scientists often refuse to change their mind. There is a saying that science progresses one death at the time to refer to the incredible stubbornness of people who once pursued Truth through reason and scientific method.

What can we do about the incurable superstitions of humanity?

21. Contributor
Henry Racette
@HenryRacette

Clavius (View Comment):
This reminds me of a story told by Moshe Rubenstein, the wonderful Professor Emeritus of problem solving at UCLA.

And it reminded me of a similar situation I and my family ran into years ago while driving through Colorado. We had a small poodle with us, and she — Lucky — began acting strangely, sluggish and uncomfortable. So we stopped at a veterinary clinic in Colorado Springs, some branch of a big national chain I’d never heard of. The vet examined Lucky and said she was either dehydrated or suffering from kidney failure. He recommended a test that cost about \$400, as I recall. I asked him what we would do if the test indicated kidney failure, and he described what I, supporting a household of two adults and six kids, would never consider a reasonable ongoing expense to incur even for a beloved family pet. I asked what we would do if the test came up negative. His answer was “hydration.” So we left, encouraged our flagging pet to drink water, and kept her for several more years.

A college friend who owned a veterinary clinic in California later informed me that tests are a huge profit center for vets.

22. Member
Muleskinner, Weasel Wrangler
@Muleskinner

Arahant (View Comment):
I suspect “Susan” would need statistics on statins, not that she’d necessarily understand them. And they probably wouldn’t change her mind.

I gave her statistics on statins. Lots of very compelling statistics.

And you’re right – it didn’t change her mind.

I suspect this is human nature. Walker Percy, who trained to be a psychiatrist, wrote about similar issues. Some patients need a name for what ails them to make them happy, even if the diagnosis is dire. He also talks about how science cannot say anything about an individual, only how an individual compares to others. (Which is exactly what statistics is about, as it generally requires a population of interest.) Somewhere, somehow, she is sure that in that stack of test results, or more tests, contains her real self. Statistics will help you make the best decisions, given all of the evidence. But that’s not what we want, tell me who I am, and what’s best for me

23. Member
Sandy
@Sandy

It’s pretty confusing being a patient.  For instance, I’ve read books by Dr. Malcolm Kendrick, whose specialty is heart disease and he loves statistics.  Doctoring Data was the first book I read, and it was very helpful in understanding what is meant when research results are reported, and to learn that most physicians–or so Kendrick claims–do not understand the difference between relative and absolute percentages.  But he has written two books arguing against the use of statins, and he bases his arguments on statistics that he tries to break down for us patients.  So you can see my problem.

Here is a little part of what he has to say on the question of how much longer one is likely to live if one takes statins, based, he says, on the Scandinavian Simvastatin Survival Study and the Heart Protection Study.   This is from his blog.

Statins do not prevent fatal heart attacks and strokes. They can only delay them. They delay them by about one or two days per year of treatment. For those who have read my books you will know that I have regularly suggested we get rid of the concept of ‘preventative medicine’. We need to replace it with the concept of ‘delayative medicine’.

You cannot stop people dying. You can only make them live longer. How much longer is the key question. With statins this question has been answered. You can, to be generous, add a maximum of two days per year to life expectancy.

24. Member
kedavis
@kedavis

Consider the global warming crowd.  They want more and more computer models.  Is the earth warming by 1.7 degrees?  Or is it 1.9 degrees?  Let’s do more studies!

Well, ok.  But if fossil fuels are dangerous, perhaps we might consider nuclear power, which results in only warm water and tiny amounts of nuclear waste which can be easily contained and managed.  Ok.  Let’s get to work.

No.  Let’s do more and more computer models.  Which we refuse to act on.

Actually, the “greenies” already have their “solution,” they only do more “studies” to try and prove what they already believe and want, and it’s the same whether it’s “global warming” or “the coming ice age”:  More government control, etc.

The less-intelligent among them probably just get off on being “natural” but it may be that those who actually know something resist nuclear power because they know or at least fear that it would actually fix the problem they claim to be concerned about.

25. Member
Randy Webster
@RandyWebster

Dr. Bastiat: But it’s easier to study these things than to fix them.

If they fixed them, a lot of people would be out of work.  Pay me big bucks to solve a problem, with no accountability, and see if it ever gets solved.

26. Member
Juliana
@Juliana

We see this in education as well. I administer IQ tests – not the greatest measure, but is supposedly a predictor of school success. I had one family who wanted their 12th grade student to be tested – even though he had been tested since he was in kindergarten (a total of about 5 or 6 times) and those tests were consistently in the moderate cognitive delay range. I refused to test as we would have done nothing with the information except add it to the list. They weren’t happy with that so they paid to have him tested at an outside agency. It’s hard to convince parents (or sometimes teachers/admin) that testing should not be done ‘just for fun.’ If it is going to provide information that helps with programming – I’m all for it. Otherwise it is simply a waste of time.

Special education teachers on the other hand, believe they MUST do standardized academic testing with each three-year re-evaluation of a special education student. (All the while complaining that they had so little time to do so.) I tried to convince them that the class work and district testing provided more relevant information that they could actually apply to helping the student. Could not convince them as they ‘needed’ those numbers – which were irrelevant – for the report to be complete.

27. Member
kedavis
@kedavis

Dr. Bastiat: But it’s easier to study these things than to fix them.

If they fixed them, a lot of people would be out of work. Pay me big bucks to solve a problem, with no accountability, and see if it ever gets solved.

No, pay ME to do it!

28. Member
Randy Webster
@RandyWebster

Henry Racette (View Comment):
In the 1960s, Daniel Moynihan saw the self-destruction of the black family as a problem to be fixed before it created the situation we are in today.

A quibble.  It wasn’t self-destruction of the black family; it was government destruction of it.

29. Contributor
Henry Racette
@HenryRacette

Henry Racette (View Comment):
In the 1960s, Daniel Moynihan saw the self-destruction of the black family as a problem to be fixed before it created the situation we are in today.

A quibble. It wasn’t self-destruction of the black family; it was government destruction of it.

A fair quibble, and worth noting.

30. Member
Randy Webster
@RandyWebster

This reminds me of a story told by Moshe Rubenstein, the wonderful Professor Emeritus of problem solving at UCLA.

He was in Israel when his 85-year old father in law passed out in the orchard in the Kibbutz. As the older male family member, he became the contact person with the hostpital. The father in law was breathing fine, but was just out cold and would not wake up. The doctor wanted to do a spinal tap to see if there was blood in the spinal fluid. Moshe asked what would the doctor would do if he found blood. The doctor responded that the normal thing to do would be to operate to stop the bleeding. Moshe said, “What, you would do brain surgery on an 85-year old man?” The doctor responded, “No, I guess that wouldn’t make sense.”

There was no spinal tap test.

Moshe was, as you are, pointing out that you do test to guide your actions. If they won’t guide your actions, don’t do the tests.

I got a screw run into my finger on the job one time.  I went to the ER because I couldn’t remember how long it had been since I’d had a tetanus shot. The ER doc was bound and determined to do an X-ray.  I asked what the X-ray would tell us.  He said it would tell us if the bone had been hit or not.  I asked what that would tell us.  He said it would tell us how long it would take to heal.  I asked, don’t you think I’ll find that out anyway?  He knew it was Workman’s Comp, and was just trying to generate revenue.