The Importance of Doubt
Or, how doubt propels science forward
š Hey,Ā AbhishekĀ here! Welcome to the 110th edition ofĀ The Sunday Wisdom.
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On to this weekās essay!
Today, letās talk about medicine.Ā Even though itās safe to assume that the field of medicine is the epitome of scientific method, ironically, it wasnāt always so. In fact it was the opposite. It was a field marred with arrogance, hubris, and a sheer lack of scientific rigour. Most importantly, what medicine lacked was doubt. Doubt is not a fearful thing and, as weāll soon learn, itās in fact what propels science forward.
Galen of Pergamon was a Greek physician, surgeon, and philosopher in the Roman Empire. Considered to be one of the most accomplished of all medical researchers, Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, pharmacology, and neurology.
His writings were the indisputable source of medical authority for more than a thousand years. He writes, āIt is I, and I alone, who has revealed the true path of medicineā. And yet Galen never conducted anything resembling an experiment.
Experiments are what people do when they arenāt sure what the truth is. Galen didnāt have a shred of doubt in his āopinionsā. Each outcome āconfirmedā he was right, no matter how shoddy the evidence might look to āsomeone less wise than the masterā. For example, he declares, āAll who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.ā
Turns out the biggest influencer of the field also suffered from confirmation bias and hubris heavily. In other words, Galen was in love with the smell of his own fart. Itās no wonder that medicine, as we know it, took a while to evolve.
For hundreds of years, physicians had far too little interest in proving what was effective. They didnāt want to let go of the idea that their judgment alone revealed the truth, so they kept doing what they did because they had always done it that way. They didnāt need scientific validation. They just āknewā. The had the God complex.
When George Washington fell ill in 1799, his physicians bled him relentlessly, dosed him with mercury to cause diarrhoea, induced vomiting, and raised blood-filled blisters by applying hot cups to his skin. A physician in Aristotleās Athens, or Neroās Rome, or medieval Paris, or Elizabethan London would have nodded in agreement at much of that hideous regimen.
Washington died a painful death. One might hope that this would have made the physicians question their methods. But in reality, Washingtonās death proved nothing about the treatment beyond that it failed to prevent his death. Itās very much possible that the treatment didnāt help at all, or in fact, it hastened his death. But these concerns were out of the question because the physicians āknewā what they were doing.
If they had any doubts about the treatment, they wouldnāt have prescribed them in the first place, would they? The treatment was effective, itās just that it wasnāt effective enough. Maybe they should have doubled down on bleeding Washington.
It takes more rigorous experimentation than ābleed the patient and see if he gets betterā to overcome misconceptions, and that was never done. Because if thereās no doubt about the efficacy of the current methods, thereās no room for improvement.
The irony is that about 50 years before George Washingtonās gruesome death, a cure for this malpractice came very close to a discovery, but was ignored for the next 170 years.
In 1747, when a British shipās doctor named James Lind took twelve sailors suffering from scurvy, divided them into pairs, and gave each pair a different treatment: vinegar, cider, sulphuric acid, seawater, a bark paste, and citrus fruit, it was an experiment born of desperation, but was also a rudimentary form of clinical trial.
In Lindās time scurvy was a terrifying disease, estimated to have killed 2 million sailors. It was a mortal threat to sailors on long-distance voyages and not even the confidence of physicians could hide the futility of their treatments. So Lind took six shots in the darkāand one hit.
The two sailors given the citrus recovered quickly. Lind established that a diet of citrus fruit prevented sailors from developing this dreaded disease, although he didnāt realise the significance of his own experiment back then. By the early 1800s, scurvy had become a problem of the past for the British navy, as all its ships took to the seas with an adequate supply of citrus fruit. This is usually the point at which history books end the story, celebrating a great triumph of the scientific method.
But itās very surprising that this completely preventable disease made an unexpected comeback a century later, when British expeditions started to explore the polar regions. The British Arctic Expedition of 1875, the Jackson-Harmsworth Expedition to the Arctic in 1894, and most notably the two expeditions of Robert Falcon Scott to Antarctica in 1903 and 1911 all suffered greatly from scurvy.
How could this have happened? A combination of ignorance and arrogance. By 1900 the leading physicians in Britain had forgotten the lessons of a century before. Dr. Reginald Koettlitz, Robert Scottās physician for the Antarctica expedition, attributed scurvy to tainted meat. Further, he added, āthe benefit of the so-calledĀ antiscorbuticsĀ (or scurvy preventatives, such as lime juice) is a delusion.ā Why? Because he just āknewā.
In his 1911 Antarctica expedition, Scott stocked dried meat that had been scrupulously inspected for signs of decay but no citrus fruits or juices. The trust he placed in the doctorās opinion contributed to the tragedy that followed. All of the five men who made it to the South Pole died. One team member turned back before the pole and made it back alive, but with a severe case of scurvy.
Not until the twentieth century did the idea of careful measurement of results and scientific rigour take hold in the field of medicine. Not until the British statistician (not a physician) Austin Bradford Hill laid out a template for modern medical investigation using Randomised Control Trials (RCT) in the 1920s.
If patients who were identical in every way were put into two groups, and the groups were treated differently, he wrote, we would know if the treatment caused any difference in outcome. It seems simple but is impossible in practice because no two people are exactly alike, not even identical twins, so the experiment will be confounded by the differences among test subjects.
But randomly assigning people to one group or the other would mean whatever differences there are among them should balance out if enough people participated in the experiment. Then we can confidently conclude if the treatment caused any differences in observed outcomes. It isnāt perfect. There is no perfection in our messy world. But it beats the hubris of wise men stroking their chins.
For centuries, medicine wasnāt science but, what Richard Feynman calls,Ā cargo cult science. It looked liked science, but there was no scientific rigour behind the regimen. It was too cocksure. It lacked doubt.
When the scientist tells you he does not know the answer, he is an ignorant man. When he tells you he has a hunch about how it is going to work, he is uncertain about it. When he is pretty sure of how it is going to work, and he tells you, āThis is the way itās going to work, Iāll bet,ā he still is in some doubt. And it is of paramount importance, in order to make progress, that we recognise this ignorance and this doubt. Because we have the doubt, we then propose looking in new directions for new ideas. The rate of the development of science is not the rate at which you make observations alone but, much more important, the rate at which you create new things to test.
ā Richard Feynman,Ā The Meaning of It All
Doubt is the essence of scientific thinking. When you donāt have doubt, you donāt measure. What you cannot measure doesnāt get better.
Interesting Finds
Introverts use the ābest possible selfā intervention to boost their optimism.Ā One reason that extroverts are bolder than average is because they tend to believe that events will go well. You donāt have to be outgoing. But if being introverted is holding you back from the life you want, dive in for a way out. Shared by Parul Kadam.
Time can expand or contract.Ā It has dimensions and qualitiesāof depth or intensityāthat transcend mere duration. A few seconds looking into someoneās eyes last an ageāthey can hold the vastness and complexity of all that you feel for them.
The way our brains seek ājust rightā levels of novelty is like going to a bookstore.Ā You wouldnāt want to pick a childrenās book or a book youāve read a lot before. On the other hand, if you choose a book you canāt penetrate at all, like, say, a Russian textbook on astrophysics, you hit a similar problem. To learn, you have to have something to grab onto: The next handhold canāt be too far from the lastāyou might never reach it.
Timeless Insight
Studies of successful founders highlight the personal attributes behind their success: courage, risk taking attitude, optimism, and so on. They conclude that all you need are these qualities to become successful. Funny thing is, the graveyard of failures is also full of people who share similar traits.
What Iām Reading
In mathematical modelling, as in all of science, we always have to make choices about what to stress and what to ignore. The art of abstraction lies in knowing what is essential and what is minutia, what is signal and what is noise, what is trend and what is wiggle. It's an art because such choices always involve an element of danger; they come close to wishful thinking and intellectual dishonesty.
ā Steven H. Strogatz,Ā Infinite Powers
Tiny Thought
When you say that you lack the time to work on the most important things, what you mean is that you lack adequate judgment, discipline, and agency.
Before You Goā¦
If you have some wisdom to share with other readersālinks, books, original thoughts, social commentary, stuff you found interesting on the internet/IRL, jokes, or anything elseāsimply send them to me. I'll pick one, mention your name, and share it in an upcoming issue.
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Until next Sunday,
Abhishek š