From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Newsgroups: sci.med
Subject: Re: Arrogance, arthritis, & Banks
Date: 1 Oct 92 15:40:12 GMT
Organization: Purdue University Statistics Department

In article <1992Oct01.092023.28930@omen.UUCP> caf@omen.UUCP (Chuck Forsberg) writes:
>In article <BvEq4L.3H@wpg.com> russ@wpg.com (Russell Lawrence) writes:
>>In article <BvB0ww.9Mv@wpg.com> russ@wpg.com (Russell Lawrence) writes:
>>>>In other words, they'll learn that it's wrong because you say it 
>>>>is.   Are your pronouncements a reasonable substitute for verifiable
>>>>information?

>>From article <16665@pitt.UUCP>, by km@cs.pitt.edu (Ken Mitchum):
>>> Look. When I go to an attourney, I ask for information and advice,
>>> not references or arguments. When most people go to a doctor, they
>>> ask for the same things. Is there any particular reason why you
>>> would think that doctors on the net would obviously lie to people,
>>> or speak on things they are not informed on?

>>Is there any reason why any licensed doctor would lie?   Questions
>>involving quackery cannot be resolved by pitting one person's
>>credentials against those of another.  

>Obviously we need a working definition of medical competence in a
>specialty to distinguish from random quacks.  I propose we define
>an "sci.med expert" (on a particular specialty) as one who has
>demonstrated a 5-year cure rate of 51 per cent or better on all
>patients with the disease/disorder in question.

This is neither adequate nor reasonable.  Just about anyone has a
cure rate far higher than that for the common cold, and nobody to
my knowledge has claimed a positive cure rate for AIDS.  Nor are
there cures known for either type of diabetes or for arthritis or
quite a few other major medical problems.

The problem is that doctors feel that they must either pontificate 
on a case or refer to a more suitable specialist.  In any case, it
is rare that doctors give the patient much information upon which
to make informed choices.  The problem is especially bad when there
are multiple problems, crossing different fields.  It is also bad
where not that much is known, such as the field of nutrition; in
this case, a recent posting on the nutrition group by a professor
of nutrition at a medical school found the knowledge of nutrition
by doctors and secretaries comparable.  It is exascerbated by the
reimbursement system, whereby only procedures are compensated, and
the necessary discussions, consultations with other physicians and
with literature and other sources, and even computations are not.

I have pointed out how one should act using decision analysis, and
that this is much more difficult than the types of behavior used by
physicians.  Doctors do not make outright lies too often, except on
such points as nutrition, but they do not always get at whatever
truth is available.  Especially in difficult cases, probabilistic
thinking is needed, and as an acknowledged expert in this area, I
can state that it is not something which can be reduced to quick
answers.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@pop.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!pop.stat!hrubin(UUCP)