CFS/ME-Brendan Clarke UCL lecture in Philosophy of Medicine course

[alex3619]

I rather think that provided the 1st statement isn't violated, then it's very legitimate (welcome even) for the 2nd to include some pretty heated engagement.

Its almost mandatory, though forceful but rational argument is how I would put it.

 

[Snow Leopard]

More seriously, that's a big and interesting problem that I'm thinking about from the evidence end. Personal experiences, anedotes, and whatnot are very low-ranked sources of evidence in e.g. GRADE and other evidence-based medicine hierarchies. Yet medicine as a clinical encounter starts with taking patient histories, and (at least as British Drs are taught - can't be sure what happens elsewhere) these personal experiences are absolutely the foundations of diagnosis and so on. So I think there's a good piece of investigation that needs doing urgently - otherwise why the doublethink?

My impression is each individual, regardless of the philosophy and science seem to have their own thresholds for the generalisation of knowledge (and implied directionalities of inferences; individual->group, group->individual). These thresholds most likely vary over time, based on prior beliefs and how much the new knowledge challenges those beliefs.

All this talk about what is or isn't a "scientific field" still suggests to me that the philosophy of science lags, rather than predicts the practise.

Scientists, given sufficient interest in the field are creative and will devise new approaches to demonstrate causation.
Attempting to reduce models of causation down to ideas like Russo-Williamson Thesis or variants will be problematic, namely the more specific you make the model, the more you reduce the sensitivity of the model and vice versa. My own view on the examples you have mentioned are as follows:

Discovery of McArdle’s syndrome. The initial discovery was insufficiently justified (to be generalised) based on statistics, it isn't until further observations are made before one should have high confidence in the findings (regardless of whether someone explicitly calculates the statistics or not). It isn't until the deeper genetic findings were confirmed that McArdle’s syndrome wasn't merely a placeholder.

The HSV link with cervical cancer likewise was a preliminary working hypothesis in the absence of stronger evidence. Albeit seemingly large amount of evidence to the naive observer. The problem is putting too much confidence in preliminary hypotheses (hence various debates about lack of replication in biomedical and psychologial sciences by Ioannidis and others). There are many potential examples across medicine which existing hypothetical models that are popular among physicians may turn out to be false, for the same reason that the HSV hypothesis turned out to be false. Scientists know that these hypothetical models are not strong theories, otherwise there would no longer be a reason to employ them. The biggest mistake is when journalists, doctors, political and corporate leaders treat these preliminary findings as confirmed facts, especially when there is substantial debate among scientists (as in ME & CFS). In practise it is rational (according to some models) to form beliefs without applying any specific thresholds of demarcation for a "justified true belief", so long as one is open to change one's view when better evidence comes along. The lack of such strict demarcations means there is always going to be debate, so the practical question is what does this mean for the behaviour of people in such debates where the outcomes are specific policies...

ME & CFS are unique in that very little money (comparatively) has been spent doing novel in-depth research, hence the continued debate and lack of understanding how replicated findings like elevated TGF-Beta and certain autoantibodes could play a role in the condition.

Another example is that of scientific creativity is macroevolution. Scientists obviously cannot go back in time to observe, so they simply developed new methods that can be tested to confirm macroevolution, namely the propogation of SNPs in conserved genes across a phylogenetic tree. Notably, how this correlates with the propogation of SNPs of viral fossils in our genomes. This is a finding which can only be made using a theory of evolution and one that clearly contradicts intelligent design. Likewise, many proteins have multiple functions that seem strange and contradictory unless looked through the lens of evolution and how predictions these proteins are necessary for the function in organisms of varying complexity and function (and their position in the phylogenetic tree).

This is an example of creative scientists, after being told "it cannot be done", devising methods of solving the problem.

 

[Woolie]

The more I see of the world the more I agree with those who say that science renders any other epistemology redundant. All that is left if you take away science is various manifestations of solipsism, which are no answer to anything.

Philosophy, including political philosophy, may have a role in helping figure out how to apply the results from science to society. But as far as generating the actual primary knowledge itself, it is basically useless.

I'm late to the party, but I agree, Sean.

This type of philosophy, where you seek opposing philosophical positions, which you evaluate without respect to the evidence, is so incredibly antiquated. Good philosophers now make contact with the evidence. They understand their topic, they don't caricature it.

There are some interesting philosophical discussions to be had with respect to MECFS, but they are about evidence standards, dealing with uncertainty and the role of psychological explanation in medicine.

 

[Woolie]

Its never inappropriate to engage in sound debate with philosophy. Its only inappropriate to make personal attacks or other fallacious arguments.

Yea, alex3619, I do love this aspect of philosophy, and wish all fields were as welcoming of proper debate aimed at the arguments/issues not at the person.

 

[alex3619]

There are some interesting philosophical discussions to be had with respect to MECFS, but they are about evidence standards, dealing with uncertainty and the role of psychological explanation in medicine.

Yes. To that I would like to see more philosophical engagement with medical thinking ... so much is so irrational. We also need concrete standards for trials and studies.

 

[Woolie]

From Brendan's conclusion.

I think there's something else going on in chronic fatigue syndrome that's really important, and I think that the missing something has to do with causation. Note that the central/essential (??) part of the definition of chronic fatigue syndrome is that it is ideopathic, it has no known cause, and I think that that kind of difficulty about causation is really important to the kind of arguments that happen in cfs about whether or not it's a disease, and we can certainly see lots of examples where chronic fatigue of some kind that is caused by an illness is treated very differently from ideopathic chronic fatigue syndrome."

No. Lots of diseases are idiopathic. Including epilepsy, Parkinson's Alzhemer's, ALS. No-one knows what caused them in most cases. The difference is, they all have visible concrete disease signatures. So he doesn't mean idiopathic at all. He means "not associated with an objectively identifiable disease signature".

 

[Skycloud]

From Brendan's conclusion.
No. Lots of diseases are idiopathic. Including epilepsy, Parkinson's Alzhemer's, ALS. No-one knows what caused them in most cases. The difference is, they all have visible concrete disease signatures. So he doesn't mean idiopathic at all. He means "not associated with an objectively identifiable disease signature".

I agree, and tend to think that establishing good diagnostic biomarkers and treatments that affect demonstrable and measurable things going on in the body will squash objections to it being a disease (sorry, can't put it better - don't have a science/medical background +cognitive disfunction)

 

[Skycloud]

In using philosophy its important to separate the methods of philosophical analysis from the content material that is analyzed.

In my honours year we had one course based on analysis of a topical book of relevance to computer science and artificial intelligence students. The book was rubbish. The course was invaluable. I actually joined in the course twice more during my PhD candidacy, without credit. It was how to go about analyzing material that at first appears obtuse or complicated that made this course so valuable. I use those skills to this day.

Quite a lot of philosophical material is irrelevant or even nonsense. Its the methods that matter more than the content.

My personal opinion is that a lot of traditional philosophical material is still used because its well understood by philosophers, and serves as a good platform to teach from.

My own background, aside from biochemistry, is in artificial intelligence. While I focused mainly on machine learning especially neural networks, a lot of my experience was in symbolic logic, theory of knowledge (including science) and philosophy of mind. It turns out my current stance is I am a critical rationalist, and beyond that a pancritical rationalist, and monist on theory of mind.

While these things have no deep relevance to ME or CFS they give rise to tools that can be applied to the ME debate. This includes the collective fallacies of things like the PACE trial, and beyond that to psychosomatic medicine.

I am deeply concerned with both the systemic failures in medical thinking, and with the cultural issues that are part of this. Evidence based medicine is in danger of being railroaded by special interest groups that distort the evidence and argument. PACE, and evidence based review processes on CBT and GET, are part of the issue that demonstrates that. Indeed, it is still my view that even the IOM report that gave us the SEID definition was based on a flawed process, though its invaluable as a political tool.

Philosophical analysis is just a collection of tools. So is mathematics. Its people and how they apply the tools, and to what issues, that help determine if its useful or not.

Ok, great! I'm a lay person (fine art background (I was an artist). Later some ecology + plant biology and horticulture). No experience of philosophy, a bit sceptical; it might exist in it's own little thinking about thinking bubble. I want to know that the highly educated scientists (and clinicians) actually think intelligently, critically and without bias, at least aspire too, about and in their work. I want to know that they are constructively picky with each other, and are transparent. Lay person that I am I can see something of those systemic failures, PACE being the beginning of my education. A fairly bright 10 year old could spot a couple of the problems fairly easily, and also spot that the adults weren't doing anything about it. I looked up critical rationalism, pancritical rationalism and theory of mind/monism to be sure of what you meant and, certainly on a cursory introduction, I think I tend to agree. I completely agree with your final sentence. Thanks

 

[alex3619]

This is an example of creative scientists, after being told "it cannot be done", devising methods of solving the problem.

Ron Davis is an example of this. "Cannot be done" becomes an engineering problem for him, and then he recruits the people needed to do it, or I suspect retrains the ones he has. He has produced technology, time and again, that does tests that ordinarily cost hundreds of dollars for a cost of only cents. That improves medical practice, but it also means good research can be conducted at much lower costs. Some of the upcoming technology, still under development and not proven, includes real time testing of patient chemistry using a wearable electronic device.