Archive for the ‘Critical Thinking’ Category

Carl Sagan’s The Demon-Haunted World Part 2: Starstuff and Our Connections to the Natural World…..

In The Most Precious Thing, the opening chapter of Sagan’s masterpiece The Demon-Haunted World: Science as a Candle in the Dark, he discusses the appeal of pseudoscience and the various belief systems held by humans throughout history. All of us try out different belief systems at one point or another as we progress through life, generally because they fulfill our emotional needs. Many of these are encountered during childhood and adolescence, but most adults try out new beliefs as well, whether it is a new religion, astrology, psychic powers, the charismatic story of a self-help guru or even an alternative medical practice like chiropractic or acupuncture.

Sagan describes how these beliefs fulfill our desires for personal powers, our hunger for spirituality and our desperate yearning for cures for diseases. They can calm our fears and reassure us that death is not the end. They can buttress our feelings of importance in creation and ensure that we are tied to the universe, if not the center of it. They can serve as a gateway to the feelings of wonder and majesty that we crave while going about seemingly mundane existences.

Sagan, as he so often does, perfectly encapsulates the feelings of folks like myself, who look to science rather than the supernatural or pseudoscientific to satisfy that aspect of human nature that has come to be known as spirituality or to provide a sense of wonder in our lives. As a counterpoint to Sagan’s approach, I always think of Yann Martel, who in his otherwise excellent book The Life of Pi takes a different tack. In the story, the main character tells two versions of his travails on the high seas on a lifeboat accompanied by an unsavory cast of characters such as a Bengal tiger and a vicious hyena. Or was it simply himself and a deranged cook? He asks which is the better story and I certainly agree with the characters in the book that are posed this question when they say that the story with the animals is.  Martel then writes, “and so it goes with God.”

Martel implies that the supernatural or pseudoscientific, in this particular case the existence of one particular version of a higher power, is the better story and is therefore more worthy of belief. To be fair, some in the religious community have not taken kindly to this assumption, equating it with postmodern claptrap, but it speaks to what the vast majority of believers, if not virtually all of humanity, is heavily influenced by. We all are emotionally impacted by a “better story” when it comes to spirituality and our connection to the natural world. Unfortunately, as countless polls over the past few decades continue to reveal our decreasing understanding of basic scientific concepts, the question is likely being begged by Martel and many others that the average person in America knows enough about science to make a fair comparison.

Sagan responds to the reality of the supernatural and pseudoscientific appealing to our human nature in typical and illuminating fashion:

“Although it’s hard for me to see a more profound cosmic connection than the astonishing findings of modern nuclear astrophysics: Except for hydrogen, all the atoms that make each of us up – the iron in our blood, the calcium in our bones, the carbon in our brains – were manufactured in red giant stars thousands of light-years away in space and billions of years ago in time. We are, as I like to say, starstuff.”

Although it helps to reveal the astonishing and awe-inspiring reality behind our existence, Sagan’s astrophysics inspired sentiment is far from enough to fully grasp the grandeur of human existence as revealed by scientific inquiry. Evolutionary theory, the linchpin of our understanding of life on Earth, describes the next phase of how we came to be here on Earth. But when Darwin published his own masterpiece in 1859, he didn’t just set in motion the means to which we might understand why modern humans are what they are. Evolutionary theory explains, simply and elegantly, how we are related in fundamental ways to all life from the bonobo and chimpanzee to the sea cucumber and even to unicellular bacteria. It reveals how, bit by bit over billions of years, life has struggled to survive in varying environments. How it has evolved countless mechanisms to improve its reproductive success via a sloppy process with no specific goal in mind. And yet here we are. No claws. Weak. Naked and soft. Flightless. Completely incapable of survival for years after we are born. Yet here we are. Social. Communicative. Resourceful. Masters of a variety of environments through our ingenuity, drive and a thin rim of neural tissue built upon a forebrain shared by all other vertebrates. Not by magic or divine whim. Not because of a universal directive or a undetectable vibrational field. Evolution, properly understood, is by far the better story and science is the key to that understanding.

I often discuss so-called “big picture” concepts such as this with my oldest daughter who has only just made six years of age. My goal is for her to grow up having a firm grasp of the beauty and majesty of science, even if she does not come to care about the specific details as much as her daddy. A few weeks ago, while watching a television program about the human body, I explained to her how we are all starstuff, born in the hearts of enormous balls of plasma held together by one of the fundamental forces of nature, and how one day our individual components will return whence they came. How in a few billion years, when the star at the center of our solar system burns up the last of its hydrogen and enters its own red giant phase, the Earth will be engulfed. Showing no signs of fear, she sat quietly for a moment. I could almost hear her brain working its way around the information.

Children are born scientists because they innately know to perform the most basic and most vital of the components of the scientific method, and they are better at it than most adults. They ask questions. A question is a celebrated occurrence in my house and it is always met with an honest answer, even if it is “I don’t know.” It is okay for children to learn that their parents are not the repositories of all human knowledge. It does them a disservice to make things up or to suppress their curiosity by dismissing their inquisitiveness. But it is only truly valuable if the “I don’t know.” Is quickly followed up by “But let’s find out.” My daughter didn’t have a question this time, although they would come over the days and weeks that followed. She thought deeply for a while, smiled and replied, “That’s really nice.”

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Carl Sagan and the Demon-Haunted World Part 1…..

I’ve been thinking about Carl Sagan a lot lately. This isn’t surprising considering what would have been his 76th birthday recently passed (November 9th), and a number of skeptical blogs and podcasts have covered this fact. Sagan passed away in 1996, a good 7 years before I stumbled into awareness of  the skeptical community, but his impact on myself and countless others since has been significant. He was, and is, a beloved icon of the skeptical movement, and deservedly so. Sagan championed reason and popularized science like none before or since.

While Sagan’s classic 1995 ode to critical thinking, The Demon-Haunted World: Science as a Candle in the Dark, wasn’t my first book focusing on science and skepticism, it certainly had the greatest impact. My personal introduction to skepticism, after watching an interview of him on the DVD extras for Penn and Teller’s television program Bullshit, was James Randi’s Flim-Flam, another classic that finds a home on many top ten lists. That book, along with the writings of Michael ShermerBob Park, Stephen Jay Gould and many others have influenced my approach to life greatly, but none like Sagan’s. It wasn’t just his ability to debunk pseudoscience, which I am especially fond of, or his ability to discuss complicated scientific topics in a way that those of us with lower intelligence quotients could grasp. Sagan’s gift was his ability to communicate the wonder of it all, the overarching beauty of a natural world with intimate connection between the tiniest elementary particles and galaxy clusters 85 million light years from Earth, or strands of nucleotide molecules and elephants. 

I’ve decided to pick up my copy of The Demon Haunted World and read it for the second time. My plan is to share what is meaningful to me as I progress through it, and to hopefully inspire others to read the book themselves.

In the first few pages of the book, Sagan wastes no time in describing one of the fundamental frustrations in skepticism. While being driven to a speaking engagement, he engages in conversation with the driver, an intelligent man with many questions about topics ranging from the supposed lost continent of Atlantis to the shroud of Turin. As Sagan politely shoots down each and every claim brought forth by the gentleman, he is struck with the notion that here is a man, curious about the natural world and motivated to learn, with a misplaced sense of awe. Rather than the wonders of scientific discovery, he is captivated by the unproven and implausible claims of pseudoscience.

Sagan writes,

“And yet there’s so much in real science that’s equally exciting, more mysterious, a greater intellectual challenge-as well as being a lot closer to the truth. Did he know about the molecular building blocks of life sitting out there in the cold, tenuous gas between the stars? Had he heard of the footprints of our ancestors found in 4-million-year-old volcanic ash? What about the raising of the Himalayas when India went crashing into Asia? Or how viruses, built like hypodermic syringes, slip their DNA past the host organism’s defenses and subvert the reproductive machinery of cells; or the radio search for extraterrestrial intelligence; or the newly discovered ancient civilization of Elba that advertised the virtues of Elba beer? No, he hadn’t heard. Nor did he know, even vaguely, about quantum indeterminacy, and he recognized DNA only as three frequently linked capital letters.”

Admittedly, the siren’s call of pseudoscience can be quite enticing. I speak from a certain degree of experience having been caught up in the world of paranormal research in my younger days. Like the driver in Sagan’s anecdote, I have always had a keen interest in understanding how things work. Not quite like my brother, who used to take apart mechanical devices so that he could put them back together, learning what makes them tick in the process, but on a more fundamental level. And I have always experienced an intellectual rush, so to speak, from learning about new scientific advances. M problem was differentiating science from baloney.

I yearned for insight into the mysteries of life but faced a number of hurdles, like cultural influences, the educational system itself and the way science is presented by the media and entertainment industries. I knew quite a few scientific facts, such as how to define a mammal, how fossils are formed or the order of the planets but I didn’t realize, hadn’t an inkling of in fact, how much there was that I didn’t know. And when I did attempt to piece together these random tidbits into a larger picture, I filled in the gaps of my understanding with what was available for easy digestion. I credulously watched television specials on alien visitors and the paranormal or read the Time Life series on ghosts and psychic powers uncritically. I even remember learning some medical “facts” from the commercials for a local chiropractor. Later, when I told my friends about it, I thought I was discussing legitimate science. I thought that these were the real mysteries of life. I didn’t have a clue what real science was or how it works.

The frustration that so many skeptics share, and certainly those involved in skeptical outreach, is that such a large impetus for belief in pseudoscience is that it fulfills the human desire for awe and wonder. But it is a meager gruel. One of the reasons why so many people look elsewhere for their wonder fix is that science is typically not presented in a flattering light to the public. Scientists are portrayed as nerds, or weird old men in white jackets with wild hair. Science is the butt of jokes and shown as boring, or overly complicated, or as just another way of understanding the universe, equal to any other. But good science, properly explained in the right context, is more awe-inspiring, more satisfying than anything that could ever be invented by the human brain.  

Sagan discusses the general state of scientific illiteracy but more importantly why it matters:

“It’s perilous and foolhardy for the average citizen to remain ignorant about global warming, say, or ozone depletion, air pollution, toxic and radioactive wastes, acid rain, topsoil erosion, tropical deforestation, exponential population growth. Jobs and wages depend on science and technology…..Consider the social ramifications of fission and fusion power, supercomputers, data “highways”, abortion, radon, massive reductions in strategic weapons, addiction, government eavesdropping on the lives of its citizens, high-resolution TV, airline and airport safety, fetal tissue transplants, health costs, food additives, drugs to ameliorate mania or depression or schizophrenia, animal rights, superconductivity, morning-after pills, alleged hereditary antisocial dispositions, space stations, going to Mars, finding cures for AIDS and cancer.

How can we affect national policy-or even make intelligent decisions in our own lives-if we don’t grasp the underlying issues?”

Despite the negative stereotype of skeptics, debunking is only a small part of what we do. Despite being much maligned, debunking is an extremely important role, but that is a topic for another post. Many of us consider the most vital role of the skeptic, however, to be that of the science popularizer. Unfortunately, very few actual scientists have proven to be any good at this. Besides Sagan, there is a very short list of people who have been able to achieve any significant mind share. Bill Nye and Neil deGrasse Tyson are two very excellent examples. A number of non-scientist skeptics have answered the call as well, but it is an uphill battle. Still there is hope. The popularity of shows like The Big Bang Theory and Mythbusters is very encouraging.

More to come.

Psychic Sperm:The Gambler’s Fallacy and the Representative Heuristic…..

Carl Sagan supposedly once said that randomness is clumpy. It is my new favorite thing to say because it is so simple and it so effortlessly explains so much about our experience with the natural world. Sagan’s ability to offer up life-changing nuggets of rational thought like this was unmatched and his efforts to bring science and reason to the public have been sorely missed since his passing in December of ’96. If you haven’t read any of Sagan’s works, I highly recommend The Demon-Haunted World: Science as a Candle in the Dark.

If you have a coin, and an hour to kill, record the results of a few hundred flips and you’ll see what Sagan meant about the nature of randomness. You will inevitably record clusters of heads or tails that seem improbable. Runs of heads or tails five, six, even seven straight times wouldn’t surprise me at all. But eventually, the outcomes will average out to about half of the flips being heads and half resulting in tails. The more trials that you perform, the closer the outcomes will approach exactly 50% for each possible result. I’m assuming you aren’t using a trick coin of course. 

I don’t think that very many people would argue with the fact that on average a coin flip is random chance, although there are still people out there who think that the Earth is flat and that Miley Cyrus isn’t a robot. But because of a deeply rooted cognitive bias, we tend to forget that randomness is clumpy. We accept the established odds overall, but not in short runs of randomness whether it is a series of coin flips or, for a more “real world” example from my line of work, the incidence of bacterial meningitis in neonates with fever. We do this despite the many cold doses of reality experienced over a lifetime of allowing the past results of a random process to influence our expectations of future results of that random process. This is the essence of the Gambler’s fallacy, an error in logic that can lead to the belief, for instance, that after five heads in a row there is a higher than 50% chance that the next flip will land on tails. There isn’t.  

The cognitive bias which results in this commonly employed logical fallacy is, as is often the case, the result of an inappropriately employed mental shortcut. These shortcuts, known as heuristics, can be very helpful but sacrifice accuracy for efficiency of thought. In the case of the Gambler’s fallacy, the representative heuristic is to blame. If someone is aware of the fact that a result has a known frequency of occurring, such as the flip of a coin or the spin of a roulette wheel, they often mistakenly make the assumption that short runs will be representative of long runs. This means that a run of ten or twenty should be equally split between heads and tails, or red and black in the case of roulette (1), in the same way that a run of a million would be. But, once again, randomness is clumpy and short runs often have surprisingly unbalanced results.   

I recently had a somewhat heated exchange on the comment section of a Facebook friend’s status update. My friend, a mother of three boys, was expecting her fourth child and had not found out yet whether this baby was a boy or a girl. She expressed her desire for a girl and a relative of my friend commented that the new baby would almost certainly be female because the odds were so highly in favor of such an outcome. It is true that the odds of having 4 boys in a row is very low, about 6%, but this was a classic example of the Gambler’s fallacy. I responded and an argument ensued.

Now I am the first to admit that I am somewhat of a drive by skeptic when it comes to Facebook. I rarely allow an opportunity for chiming in when I disagree with a comment to pass by. And I further admit that I recognize that this is probably a character flaw of mine, and that I have made more than a few people rather angry or at the very least somewhat uncomfortable when their comment section is hijacked. My wife thinks I’m as ass, and as with most things, she is almost certainly correct in her assessment. I’m working on it, but I just couldn’t pass up such a beautiful hanging curveball.

So what were the odds of my friend’s child being a girl? There are two ways to approach this problem with one of them being right and one possibly seeming right because of the representative heuristic. Readers of this blog should know that what feels right on a gut level is often completely wrong. First though, some basics on the determination of sex in humans (2).

Human infants are generally born as either male or female and the determination of sex is based on genetics. Most mammals, humans included, select gender using an XY system that most of you are probably fairly familiar with even if you don’t remember the specifics. Modern humans, individuals with genetic syndromes aside, have a genome which consists of 23 paired chromosomes. The pair that determines an individual’s sex are, not suprisingly, called sex chromosomes. Females generally have two X chromosomes (XX) and males have both an X and a Y chromosome (XY). It is widely considered, although there is some controversy, that human zygotes are inherently on the path towards being female at conception and that, if present, a single gene located on the Y chromosome alters this course resulting in male offspring (3).

Most cells in the human body are identified as diploid, which means that they contain the above mentioned 23 pairs of chromosomes (4). Reproductive cells like sperm and ova, known as gametes, are haploid in that they only contain one set of the 23 human chromosomes. This make sense because they will combine to form a diploid zygote at conception. The female ovum always contains an X chromosome. It is the male sperm which ultimately will determine sex because an individual sperm can carry an X or a Y chromosome. Which sperm fertilizes the impatiently waiting ovum is a crapshoot and it works out to a roughly 50/50 split between male and female embryos (5). Studies looking at large numbers of families have shown conclusively that even in the case of families with long runs of male or female children, the chance that a subsequent child will be male or female remains pretty close to 50/50.

So in the case of my friend with 3 boys and a bun in the oven, the likelihood of having another boy was 50%, not 6.25%. And the chance of finally having a girl was 50%. But let’s further explore the notion so strongly argued by my friend’s relative, that the sex of previous children impacts the sex of future children. As I’ve already explained, there is a perfectly reasonable cognitive bias to blame for this fallacious logic, the misuse of the representative heuristic. But for argument’s sake let’s assume that he was right. What would the mechanism for this be? How would past results impact future results of a seemingly random process like sex determination? Somehow the male sperm would have to be cognizant of the sex of prior children and to intentionally select an X or a Y chromosome carrying champion to breach the defenses of the female genital tract and fertilize the ovum, perhaps in an effort to maintain the appearance of randomness over multiple pregnancies. These diabolical sperm must apparently act to prevent our awareness of a grand conspiracy which hinges on there being a roughly equal number of male and female offspring. Are they psychic and able to probe the inner recesses of the male mind? We may never know the answer but there is something I do know: don’t anthropomorphize sperm, they hate that!

(1) I realize that the odds of that little white ball landing in a red or black slot isn’t exactly 50/50. The 0 and 00 green slots give the house a little edge. So does the booze.

(2) As opposed to alligators, for instance, the sex of which are impacted by temperature variations rather than genetics.

(3) Usually. Sex determination is very complex. There are certainly instance where the genotype (XX or XY) doesn’t match with the phenotype (outward appearance) but these are quite rare and beyond the scope of this post.

(4) This isn’t entirely accurate. Most cells in the human body are bacterial.

(5) There is some nuance to this naturally. There is the possibility of a minor influence by environmental factors or factors inherent to sperm carrying X versus Y chromosomes which may lead to a slightly increased chance of male versus female offspring in some women, or a slightly higher rate of male births than female across populations, but these differences are not meaningful. And unless you are making use of gender selection via technology, such as with IVF, any environmental changes made by families to encourage the birth of a prefered sex will not alter the outcome.

Is Your Doctor Psychic? Probably not. Or is She?…..

How is a doctor like a psychic? The answer is surprisingly simple. Despite sounding like the introduction for a bad joke, along the lines of “What is the difference between a doctor and a chiropractor?”, the comparison of physicians to those individuals claiming to call upon supernatural powers to gain access to previously unknown information holds true……sort of. 

Like psychics, doctors make use of a particular set of unique skills to extract personal information from their patients. This is often done in such a way that patients are unaware of just how much they have revealed about themselves. This always involves simple and direct questioning, such as when the doctor asks a patient about their symptoms or whether they have had any surgeries in the past. But many of the questions asked by physicians do not intuitively have any connection to a patient’s concerns, such as when I recently asked the parent of a child with bloody diarrhea if they owned any turtles. Or when I asked the parent of a jaundiced infant if gallstones run in their family. A good doctor often must read between the lines and connect seemingly disparate lines of evidence to arrive at a conclusion which may not be obvious to the patient or family. And though the doctor is able to figure things out that they didn’t directly ask about, and had no foreknowledge of, no psychic powers are necessary.  

The psychic, when performing a reading for a client, also probes or fishes for information. Sometimes they ask obvious questions, such as if the client has been having problems at work. Sometimes they make statements, such as when a psychic senses a problem in client’s chest or feels that someone from beyond the grave, whose name starts with an M, is present. Both physicians and psychics also make use of a visual examination to add to their impression about the patient or client, with hopefully only the doctor putting any physical examination skills into use. They both play the odds, making assumptions based on how likely something is to be true. A physician, for example, may look at a 5-day-old severely jaundiced infant at their newborn follow-up visit and, with a fair amount of confidence, focus the initial discussion on interventions for breastfeeding difficulty. Similarly, a psychic may look at a tearful young woman with no wedding ring on and bags under her eyes from a lack of sleep and make a high-yield assumption that she is having a relationship problem. But such indirect techniques are not necessary to be a highly successful psychic. 

I’ll go ahead and reveal, not that it will come as a surprise to regular readers, that the evidence supporting the existence of psychic abilities is weak and doesn’t support acceptance. But it is accepted by large percentages of the American public despite a lack of both plausibility and of supporting research. It is easy to understand why, once reason has been set aside and a belief in psychic powers initiated, this belief is resistant to the assault of rational explanations. As with other similarly implausible notions, such as the proposed impact of the full moon on psychiatric symptoms or birth rates, confirmation bias serves as a powerful means of protection. Because of confirmation bias, we only seek out or remember information that confirms our beliefs. And we selectively interpret new information in such a way that our beliefs are not negatively impacted, thus avoiding the dreaded entity known as cognitive dissonance. When confronted, believers will generally offer up anecdotes and, in some instances, poorly designed pseudo-research but these primarily serve as means to prevent loss of belief. The big question is why do we believe in the first place?

It would be easy for me to chalk belief in psychic powers up to mental illness, or to gullibility. I could assume that all psychics are frauds and that they use trickery to convince us (1).  I’m sure that many believers are nuts, and that many psychics are intentionally manipulating people for potential fame and fortune, but I’d wager these are in the minority. Most folks, psychic are psychic friend, are simply deluded, having fallen victim to what essentially are glitches in the otherwise pretty effective functionality of the human brain.

The human brain, magnificent though it may be, is perfectly suited for belief in the supernatural. Among the many traits that make humans successful as a species is our ability, if not our uncontrollable drive, to connect the dots. Our ability and urge to put two and two together, or however else you want to describe this uniquely human(2) capability, is a direct result of the evolutionary path we have stumbled onto. And it has always been at the heart of humanity wide improvement projects. But having a plump neocortex isn’t all vaccines and moon landings, unfortunately. With great brainpower comes an equally great ability to fool ourselves, and it has led to a vast array of irrational convictions and superstitious beliefs.

The reason for this is that, as good as we are finding meaning where it exists, we are equally adept at finding meaning where it doesn’t. We force patterns in random stimuli. We strive to piece together unrelated data points. Only humans, for example, can look at the pattern in a pine door and see the face of Jesus or hear discernible and meaningful words amongst the gibberish of a Beatles’ song played in reverse. And, because we just can’t help it, we absolutely love to make everything about us. The entire universe was created with us in mind, after all. At least it was according to the majority of humans alive today. But we are even better at this when it comes to making sense out of the world on a personal level. This is the very essence of superstition, isn’t it? The absurd belief that not only my life can be negatively or positively effected by meaningless actions such as walking under a ladder or carrying around a lucky rabbit’s foot, but the lives of others as well. The egotism involved in believing that forgetting to wear a pair of lucky socks might result in a football team losing a game is staggering. It is the assignment of personal significance to meaningless information that sets us up to fall for the primary means of being fooled, or fooling ourselves, into believing that some people, including ourselves, have psychic abilities. This fundamental method of deception is known as cold reading.

Cold reading is a method of manipulation that can be purposefully put into use by a trained charlatan to give the impression that they possess abilities beyond the natural world. It involves a variety of techniques that lead to the offering up of information, not by the psychic but by the person who has sought out the psychic(3) for guidance, or that take advantage of the human drive to find personal meaning in vague or random data.  The general approach of the psychic is to throw out vague statements or questions and allow the client to either give visual cues that they have found meaning in something, perhaps with a slight smile or a change in body positioning, or to give verbal feedback which helps guide the reading down a certain path.

The following is an example of how a typical cold reading session might go:

Psychic Jim (PJ): I’m sensing a disturbance in your chest. Have you had problems with your heart, or your lungs, or anything in the chest?

Subject Sally (SS): Well, I cracked a rib once during a fight.

PJ: The spirits are telling me there has been conflict in your past, but no resolution. You should find this person and seek to make peace in order to find true happiness.

SS: It was during a kickboxing class and my partner accidentally kicked me in the side too hard. There weren’t any hard feelings.

PJ: Great! The spirits were unclear whether this conflict was in the past or if it was a current issue in your life. They are telling me that you have an easy-going nature. You are capable of forgiveness when others might become bound up in negativity. That shows great strength as a person!

Or like this:

Psychic Jim (PJ): There is someone here with us today Sally. The mist is heavy around them but I’m sensing a male figure who passed on recently.

Subject Sally (SS): One of the guys at the office died last week. A heart attack. We weren’t close. He was a hard worker though, and a nice guy. His name was Tim.

PJ: I’m sensing regret. Tim is telling me that he didn’t feel close to you and he wished he would have made an effort to get to know you. He’s saying that you were always such a positive presence at work. He says that you deserve a promotion!

SS: It’s my company. How could I be promoted?

PJ: The mist is heavy around Tim, I’m barely sensing him. He says that you were wonderful to work for.

Do you think that Psychic Jim demonstrated mysterious supernatural abilities? Subject Sally most likely does. Psychic Jim knows he doesn’t have to be right every time, or even very often. Or at all. He just had to make vague statements or questions and she filled in the details. He also skillfully was able to change directions when a path hit a dead-end, as it did when Sally revealed that Tim was an employee of hers and not a co-worker. Sally will very likely misremember that the information she gave, the cracked rib and the deceased man at work, was provided by the psychic. She will remember those pseudohits and forget the blatant misses. People want to believe, they want there to be meaning in the psychics statements, so they will force it and their brain will warp the memory. The positive nature of the psychics claims, that Tim was telling him how wonderful she is, only increases the likelihood of this happening. Psychics know that telling clients what they want to hear is the surest way to insure repeat business (4). This is why their readings consist of vague yet positive statements, along the lines of newspaper astrology sections, that almost anyone would feel fit them well. After all, don’t we all wish to be strong, capable of forgiveness and a positive presence at work!

Cold reading isn’t just a tool of charlatans, however. These techniques come into play unintentionally all the time. Some so-called psychics hone the skill over time with study and practice but many people are also naturally good at them. They are the people who consider themselves intuitive and really good at reading people. Rarely do these people believe that they are using psychic powers though but they also rarely understand that their ability isn’t all that special. Anyone can learn to convincingly cold read. Anyone can be a psychic. So it is easy to see how some professional mediums may actually believe that they have a special gift unexplainable by science, and that they are truly helping people. I disagree. Regardless of the intention, deception is very rarely justified.

So is your doctor a psychic? He or she is no more or no less psychic than that Tarot card reader in the local strip mall or even famous psychics like Sylvia Brown. As a doctor, I can promise you that if I were truly psychic it would make my job and my life much easier.

For a more humorous (in my opinion) take on the subject of cold reading, check out this satirical news story.

(1). They do use trickery in many instances of course. This post is about the practice of cold reading but there also exists what is known as hot reading. If you visit a psychic, or see one on television, who makes very specific claims be skeptical. There are innumerable cases of psychics and faith healers being busted using a variety of techniques to obtain information from a client or audience member without their knowledge. Infamous faith healer Peter Popov’s wife would mingle with a crowd before a show and then relay information she picked up to him via a hidden earpiece microphone. An episode of Penn and Teller’s Bullshit showed how a famous psychic invited friends of her publicist to a showing which was to be filmed for the program, and visited with the group prior to the reading. The episode showed how she clearly regurgitated information she had acquired during the informal pre-show chat as if she had obtained it using her psychic intuition. Also, use of the internet has made life much easier for so-called psychics looking for info on future clients.

(2). I know, I know. Simmer down all you animal lovers. I fully realize that there are myriad examples of problem solving in other species, even perhaps a limited grasp of the concept of time. I argue, however, that it is uniquely human to have a true understanding of cause and effect and an ability to make sense out of our environment to the degree that we do, for better or for worse. Although sometimes I think my cat Molly might be smarter than she looks. My dog Sock is just plain dumb though.

(3). I don’t mean to just pick on psychics here. Cold reading is a technique that is put into use by astrologers, faith healers, salesman, psychologists, and yes even well-meaning physicians.

(4). A psychic who likes to tell clients that their dead uncle thinks they were a douchebag will have short sessions.

Compartment Syndrome: The Last and Best Defense Against Reason…..

How does a dedicated and highly intelligent physician practice quality evidence-based medicine and recommend homeopathy? How do they approach the decision to initiate antibiotics or to order a heparin drip scientifically, while at the same time they uncritically accept claims that magical memory water can impact the course of skin disorders like psoriasis or “boost” the immune system? The answer is compartment syndrome.

Medically speaking, compartment syndrome occurs when there is increased pressure within an enclosed space in the body. This pathologically increased pressure can lead to compression of vital structures such as nerves and blood vessels, and can ultimately lead to tissue death due to a lack of oxygenation.  I deal with this every now and then in my line of work as a pediatric hospitalist, usually when a patient has suffered some kind of musculoskeletal injury or has a serious bacterial infection involving muscle or other deep tissues, but it is fairly rare. What I encounter much more frequently, however, is more of a  mental compartment syndrome. Like medical compartment syndrome, the  psychological equivalent leads to the obstruction of reason which can result in a false understanding of reality and the subsequent acquiring of new and often increasingly untenable beliefs. And while those that suffer from it tend to incur less risk of direct physical harm compared to medical compartment syndrome, it is still something which should be taken seriously because there is the potential for disastrous results such as loss of money, relationships, or even one’s health.

All of us, even the most hardcore of skeptics*, has at least one superstition or one implausible belief that doesn’t hold up to scrutiny. This is because nobody is immune to the hardwired flaws in our ability to interpret the natural world. We see patterns where none exist. We assign undeserved causation based on our inherent susceptibility to anecdotal evidence. Our memories are imprecise and malleable with time and retellings. And we are capable of erecting these seemingly impenetrable walls around our beliefs that protect them from disconfirming information.

Why do we do this? Why do we take certain aspects of ourselves and separate them from other aspects of ourselves that are diametric, as exemplified by our fictional physician, who holds a firm belief in an absurd pseudoscience while actively supporting science-based medicine in all other areas of her practice? It all boils down to the avoidance of mental anxiety. This feeling of unease, or cognitive dissonance as it has come to be known in psychology, motivates us to take action to avoid it. This action typically comes in the form of defense mechanisms like confirmation bias and a variety of rationalizations. The fictional homeopathy-supporting medical doctor might simply ignore studies that don’t support her belief, or chalk negative studies up to undisclosed bias or the inability of “western science to study homeopathy”, all without realizing how this is a significant departure from her usual approach to the evaluation of evidence for or against a scientific claim.

Another example, and one that I’ve experienced on a number of occasions, is the defense mechanism that occurs when a parent is confronted with dissonance inducing information that calls into question choices they have made in the care of their child that have led to a poor medical outcome. I have experienced this most often with the parents of unimmunized children who have developed a vaccine preventable illness, but I have also had similar interactions with parents who have refused appropriate medical care for their ill child. The response is often one of demonizing the authority figure presenting the information, in this case me, or the medical establishment in general. The cognitive dissonance resulting from the acceptance that an irrational decision led to the suffering of one’s own child would be staggering and recovery from it would be difficult. Casting the physician as the bad guy, perhaps in the pocket of “Big Pharma”, serves as a convenient means of disregarding that information and avoiding the dissonance. The sad fact is that most people, when confronted with information such as this, dig in their heels and become further entrenched in the belief system, be it anti-vaccine paranoia or medical conspiracy theories, and the compartment walls become further reinforced.

I don’t pretend that writing posts such as this, or speaking at conferences about the benefits of practicing skeptical science-based medicine, will tear down or even weaken a solidly built mental compartment. But not every belief is as absurd, not every wall as sturdy. We all have these compartments protecting our beliefs and some of them, even in the most hardcore of believers, are just asking to be demolished. There are many people who are simply unaware of these concepts and knowledge of them might help some avoid a logical fallacy or two in the future. My goal is to help provide the dynamite to those who want to use it, and to perhaps stop construction of a wall before plans are even drawn up.

*For the longest time, when discussing this concept with others, I’ve thought myself an exception. I’m not. While watching television recently, I began turning down the volume to better hear something my daughter was saying to my wife. I watched as the volume counter descended. My television is very imprecise in this endeavor, the volume counter coasting sometimes several increments after removing pressure from the button on my remote. On this occasion it settled on the number 13. I immediately felt uncomfortable and dropped it down a little further. I then felt rather silly. Did I really believe that some calamity would befall myself or my family because of the television volume being left on the dreaded number 13? Of course not. But, then again, if something bad did happen how would I know it wasn’t because of it? Thankfully my volume counter doesn’t go up to 2012.

Top Ten Phrases That My Residents Will Be Tired of Hearing After Three Years…..

1. The three most dangerous words in medicine are “In my experience…..”

2. Don’t poke the skunk!

3. Don’t just do something, stand there!

4. Bad things get worse, not bad things get better or stay the same.

5. The plural of anecdote is anecdotes, not data.

6. The most successful interactions with patients and other medical professionals occur when they think it was their idea to do what you wanted them to do all along.

7. Sometimes kids forget to read the textbook chapter that discusses their diagnosis.

8.  Never underestimate the ability of the human brain to fool itself, especially your own.

9. You can swing a dead cat over the kids bed and he’ll get better as long as you do it for (insert time frame for typical resolution of self-limited illness).

10. Don’t believe anything a patient or family tells you about what another medical professional said to them.

Bonus (No longer said since I don’t take care of newborns anymore): It’s generally poor form to send a kid home without an anus.

Foundations of Skepticism: Confirmation Bias…..

In a prior post, I described one of the most vital supporting pillars of skepticism: the requirement for increasingly powerful evidence in support of claims that push the limits of plausibility and call into question fundamental aspects of our scientific knowledge. In this post, I’m going to reveal an inherent flaw in our ability to accurately interpret causal relationships in the natural world. This flaw, known as confirmation bias, serves as the driving force behind almost all unfounded belief systems and the primary reason why anecdotes and testimonials are unreliable.

Examples of confirmation bias are all around us. Nobody is completely immune to its sirens’ call, and partial immunity can only occur with awareness of the concept and a constant struggle to avoid its influence. The feeling one experiences when realizing that they are wrong, especially regarding something that they are emotionally invested in, is unpleasant to say the least. Our brains, and thus our minds, have evolved to avoid this feeling even if we must sacrifice an accurate assessment of reality. We do this via three different mechanisms, all of which revolve around our tendency towards biased selection of information that supports what we already believe to be true.

1. The selective collection only of information that confirms (biased collection)
2. The selective interpretation of information in such a way that confirms (biased interpretation)
3. The selective recollection of only information that confirms (biased recall)

The net effect of these mental mechanisms is the overemphasizing of only some of the available data or information regarding a claim. The best example that comes to mind, and one which melds this topic with the practice of medicine, is that of the commonly held belief in so-called lunar effects. This is the hypothesis that the full moon has effects on the human body. These include effects such as increased rates of mental illness and suicide, and spikes in birthrates. High percentages of medical and law enforcement professionals accept lunar effects as a true phenomenon despite the fact that they are highly implausible and have been thoroughly disproven by the collective data of over 100 studies. So why does this pervasive belief persist?

The answer is confirmation bias.

When a strange event occurs, or there is an odd cluster of events, during a full moon, such as the unlikely need for the delivery of a baby in a pediatric emergency department, many will  assign a causal relationship (biased interpretation) because they already believe in lunar effects. Others may make the connection for the first time because of prior exposure to legendary effects of the moon as with werewolves or its association with witchcraft, or because, after the fact, they hear of the many unusual things that have happened during a full moon from coworkers (biased collection). They may link the full moon to the strange event simply because humans are uncomfortable with the random nature of the natural world and a full moon is sexy. As storytelling primates, we often force explanations where none exist, and we love a good tale. This is what humans have evolved to do, and we do it better than any other species. At times, we do it too well. When a strange event or cluster of events occurs when the moon isn’t full, no connection is made. We do not interpret this as evidence against the previously assigned causal relationship (more biased interpretation).

Over the years, as the number of shifts in the ED pile up and random weird events continue to occur both during and not during the presence of a full moon, we tend to only remember the former (selective recall). Also, because human memory is malleable and changes with time and multiple retellings as in a childhood game of Telephone, strange events that did not occur during a full moon can drift to fit our beliefs. The occurrence of an ED delivery two weeks before and five days after a full moon two years ago may morph into that night we had two babies born during a full moon. The memory, although as false as a blatant lie, is no less real to the individual recalling it.

All of this is reinforced by the popularity of the belief, and to a lesser degree by misconceptions regarding the actual effects of the moon on the earth. Think tidal forces. Yes, it is true that the human body is largely made of water but in reality I am exerting more of a tidal force, or gravitational pull, on my keyboard as I type this than the moon does from 239,000 miles away. In fact, there is more gravitational pull on the earth during a new moon than a full one because a new moon lines up with the sun. But because of the dramatic visual stimuli that a full moon provides, this post isn’t about new moon madness.

So what are we do to about confirmation bias? Is it really an unavoidable pitfall? Well, perhaps not entirely unavoidable but it is an obstacle that has felled even the most powerful of minds. The best defensive strategy against this hardwired mental defect is an understanding of the fallability of human perception. The best offensive measure is  active exposure to information that does not fit within the cozy confines of our personal worldview. And giving scientific discovery more weight than personal anecdotes wouldn’t hurt either.

Zebras and the Availability Heuristic…..

During a recent shift, I spent the better part of two hours with a patient’s family discussing the unexpected discovery of a large lesion in their child’s brain. The implications of the finding were grave, and the family was devastated. This was the first time I have made such a diagnosis, and by far the hardest news I’ve had to break in my seven years as a pediatrician. It is an experience that I will never forget, and one I’ve yet to fully recover from at this point.

The diagnosis was, as previously stated, fairly unexpected. There were red flags that appropriately led to the ordering of neuroimaging however. This wasn’t based on a hunch or fear of a lawsuit, as happens far too often in the practice of modern medicine. There was enough concern to go on the encephalic expedition, but the findings were still a shock. My emotional response to the situation was intense and, as often happens, it got me thinking.

In medical school, there is an old adage often passed down by more seasoned physicians that serves to reign in an over imaginative differential diagnosis. When one hears the sound of approaching hoofbeats, inexperienced students are frequently cautioned, one should expect to see horses rather than zebras. Horses, which can be and often are very serious, are common. Horses make the most sense in the setting of hoofbeats. Of course, what is considered a horse may change depending on your location. Measles is a horse in some areas of the world, but it is most certainly a zebra in the United States…..for now. That may change in the future if the anti-vaccine crowd gets their way. But the cranium of the poor child in my above anecdote contained a zebra, a roughly 7cm by 6cm zebra nestled in the left hemisphere of her brain.

When a medical practitioners emerges from such an encounter, they stand at a point of divergence. There are two potential paths that can be taken, and the one which is most hardwired in the human brain is, as is frequently the case, the wrong choice. It would be foolish of me to deny the plain and simple fact that in the practice of medicine our prior experiences inform our future choices. For medical students and residents, there is certainly ample opportunity to learn from mistakes made when caring for ill patients. This is a process that should never end, although the opportunities are hopefully fewer with increasing knowledge and experience.

One potential path, the right one in fact, is one of appropriate assimilation of an emotionally significant and uncommon occurrence into one’s practice. It involves the use of the occurrence as a means of teaching others, of emphasizing historical red flags and abnormal physical exam findings that should lead to reasonable evidence-based testing, and of improving communication with patients and families. And it certainly allows for the experience to serve as an impetus for introspection and growth as a physician and a person. The alternate route, unfortunately, makes more sense. And it seems intuitive considering the horrendous impact on the patient and her family. The ultimate destination of this path is the placement of more importance on personal experience than on objective evidence, and it is a dangerous direction to take.

Prior experience impacts future decisions, of this there is no doubt. But this can be taken to an extreme in the practice of medicine in part because of something described by psychologists as the availability heuristic. What is a heuristic? The term may be unfamiliar, but you have experienced the phenomenon on a daily basis. It is, in fact, an unavoidable and often quite beneficial result of the evolution of the human brain. A heuristic is a rule-of-thumb, a seemingly common sense mental technique, based on experience, that allows for more efficient understanding of our environment. But heuristics tend to sacrifice accuracy for the ability to arrive at a solution more quickly. 

The availability heuristic is a specific example that is frequently employed by physicians. It warps our perception of the likelihood of a diagnosis because we tend to place more emphasis on that which can easily be brought to mind. Emotionally charged experiences are typically the ones we recall most readily. For the remainder of my career, whenever I care for a child with a presentation remotely similar to the one mentioned at the beginning of this post, I will see her face. I will see the face of her parents. I will think of the empty feeling I felt in the pit of my stomach when I heard that the radiologist wanted to speak to me. And I will recall the images on the computer screen which revealed the fist sized tumor in this precious child’s cerebrum. My human nature, developed over hundreds of thousands of years of evolution, will demand action. That action will come in the form of more testing and more imaging. Or will it? Armed with an understanding of how good thinking can go bad, and how the human brain is hardwired to make rash judgements, will I ignore that voice in the back of my head calling for unnecessary testing and imaging, with all of the potential risks that they carry with them? I think so, but I am only human after all.

Foundations of Skepticism: Extraordinary Claims…..

The oft heard battle cry of the charging skeptic, that extraordinary claims require extraordinary evidence, is much more than a debate talking point. It is, after the scientific method, the most important fundamental principle of the skeptical approach to understanding the universe. And despite what proponents of pseudoscience and supernatural belief systems might claim when confronted, that the skeptic is closed-minded and should accept lower orders of evidence, it really isn’t all that controversial.

Everyone incorporates the extraordinary evidence requirement into their daily lives, even the most ardent of believers. If, for example, I told you that I had a penny in my left jacket pocket, you would be unlikely to protest. This is a routine occurence after all. The claim of transporting 1,000 pennies in this fashion would likely lead to instinctive doubt and the visual inspection of my left pocket, looking for the telltale effect of their weight, but you would be unlikely to call out for more powerful proof. Were I to claim that I just so happened to be carrying a Faberge Egg around, you would certainly request that I put my money where my mouth is. The chance that I would have one of these immensely valuable and rare entities is extremely low and calls for more than the anecdotal testimony I had provided.

Another example, and one more in line with my particular expertise, is that of homeopathy. For those uninitiated in the history and practice of homeopathy, here is a quick review. Roughly 200 years ago a German physician named Samuel Christian Friedrich Hahnemann grew disillusioned with the practice of medicine. He was right to question the trends of the day, which included practices such as bloodletting and dosing patients with mercury based compounds. Pre-scientific medicine often led to a worse outcome than if no treatment had been provided at all. But proponents of these modalities, like pushers of complementary and alternative medicine today, based their beliefs on anecdotal evidence and were led astray, just as Hahnemann soon would be.

Hahnemann noticed that the untoward side-effects of taking quinine, one of the only truly effective medications of the day, were similar to the actual symptoms of the malaria it was used to treat. He decided, based on his equally pre-scientific understanding of nature, influenced by a hefty helping of magical thinking, that the ingestion of a substance which causes a certain set of symptoms in healthy individuals will cure those same symptoms in the ill patient. He then set out to uncover the true curative power of every natural substance he could get his hands on. By collecting countless anecdotal experiences from healthy volunteers, usually friends and family members, he catalogued the supposed effects of these substances so that he might match the right substance with the right symptoms in his patients. The results were quite comical, as would be expected with such a process, with each substance being associated with long lists of symptoms ranging from the typical, such as nausea, to the ridiculous, such as feeling chills only between certain hours of the day or dreaming of criminals. No attention was paid towards whether or not these symptoms were coincidence or a result of influence by Hahnemann himself.

Hahnemann went on to invent the notion that more dilute concoctions were more effective. This led to the absurd dilutions commonplace in homeopathy today, most of which lead to treatments containing no molecules of the original substance. So when a homeopath recommends the ingestion of Toxicodendron radicans to cure your itch, you have little to fear of an allergic reaction to the poison ivy in the bottle or pill because, well, there is no poison ivy in the bottle or pill. And when an over-the-counter homeopathic conjunctivitis cure has belladonna listed as an active ingredient, you don’t need to call your local poison control center. You may have thrown good money down the toilet but you probably haven’t ingested one of the most toxic plants known to man. Of course there are many preparations of homeopathic remedies sold with measurable amounts of the original substances, and because of lax laws regulating quackery in America, a topic for another post, you can never really be sure that the carpet matches the drapes. There are known examples of companies using the homeopathic label to avoid the prying eyes of the FDA.

Despite over 200 years of use, there has yet to be shown a beneficial effect of any homeopathic remedy for any condition in properly designed studies, and it is widely considered by scientists and physicians that homeopathy is no better than placebo. This should come as no surprise because, despite the 200 years since its discovery, the claims of “like treats like” and of increasing efficacy with increasing dilution have never made any sense on a basic sciences level. They have zero plausibility and proponents have resorted to claims of magical water memory and quantum physics as mechanisms of action for their treatments when confronted with reality. Homeopathy stands alone at the top of the crap pile that is alternative medicine.

So when someone offers up a homeopathic remedy to cure what ails you, it is not closed-minded to expect extraordinary evidence to support such claims any more than it would be to expect a peek at that priceless piece of artwork stuffed in the left pocket of my fleece jacket. I might be fooled. I might be lying. On a personal level, it works for me just doesn’t qualify. Placebo effects and other biases inherent in determinations of efficacy can easily account for such a belief. And when it comes to specific remedies proposed by individual practitioners or the companies who profit from their sale, collections of anecdotes and testimonials are not enough. And for something that violates fundamental laws of nature like homeopathy does, a few equivocal studies are meaningless. Even a few outright positive studies should not be enough to convince you. Homeopathy is as extraordinary as it gets and the evidence should be huge. It should be so blatantly obvious that to deny it would be just as crazy as it was to believe in homeopathy in the first place.

Not everything is as off-the-charts crazy as homeopathy of course. Some claims naturally have more merit or plausibility than others. And there is no universally agreed upon algorithm for just how much evidence is enough for each specific claim. But as a general approach, the expectation of better evidence for claims less likely to be true has served humanity well. Unfortunately however, the human brain is hardwired to work against us when it comes to the appropriate acceptance of ideas even as it is equally hardwired to continually come up with new ones, and we must strive diligently to avoid being fooled by ourselves. Examples of the negative consequences of failure to do so are all around us, from ignorant entertainers spouting harmful anti-vaccine rhetoric to Nobel Prize winning scientists championing bogus cancer cures. The skeptical community is growing faster than ever, and slowly gaining more influence, but it is an uphill battle at this point. But I remain optimistic about the outcome.

Skepticism and the Ad Hominem Fallacy…..

A few nights ago I happened to catch a thought-provoking line of dialogue while channel surfing. A fictional program involving alien visitors to Earth made use of the standard meet-cute to introduce a rugged, no-nonsense cab driver and a scientist specializing in astronomical anomalies. The astrophysicist, a believer in UFO visitation, called the cabbie a closed-minded skeptic. While I have no doubt that this was not the writer’s desired outcome, the character’s words were upsetting. They evoked a visceral feeling of intense frustration.

I’ve experienced such a sentiment many times before. All outspoken skeptics have. Usually it emerges, as depicted in the aforementioned film, via an offhand response to the questioning of a firmly held belief. Occasionally, it is expressed in more descriptive and well thought out language, such as in a more substantial discussion or a formal debate. Regardless, the intention and underlying psychological impetus is the same. And, it is always part of an ad hominem argument.

An ad hominem, as described by the New England Skeptical Society, “attempts to counter another’s claims or conclusions by attacking the person, rather than addressing the argument itself.” On their list of the top 20 logical fallacies, they use as a prime example of an ad hominem argument the very same one put into use by the movie’s UFO proponent: calling the skeptic closed-minded.

I have no doubt that some self-described skeptics are closed-minded. The term skeptic isn’t an earned degree. It isn’t regulated by some government agency. Anyone can claim the title and many do undeservedly. As a rather depressing example, take for instance the small but vocal community of so-called 9/11 skeptics that claim the terrorist attacks were perpetrated by our own government. And even if someone taking a legitimate skeptical stance on a topic is truly closed-minded, it has no bearing on whether their argument is valid. In a similar vein, just because a person arguing that the earth is flat, or some other absurdity, is a certified nut, calling them such is not a rational rebuttal to the claim. The door swings both ways.

In reality, a successful skeptic, at least in the overwhelming majority of instances(1), is the polar opposite of closed-minded. Open mindedness is, in fact, a bedrock foundation of the practice of skepticism. Like science, skepticism is a method of interpreting the world around us, and of accepting a claim only based on reason and the best evidence at their disposal, and then only provisionally. A skeptic is comfortable withholding judgement until such evidence is proffered, and ready to adjust any conclusion as better evidence becomes available.

In a general sense, it is the true believer and not the skeptic that has shut their mind against the interference of reality with their deeply held conviction. As QualiaSoup so succinctly explains in his brief but brilliant video on the subject of using a call for open-mindedness as an argument in support of a belief, open-mindedness is really just code for “agree with me!”.

Skeptics may dedicate their lives to speaking out against a variety of belief systems, from alternative medicine to zermatism, but at heart we would love for a lot of it to be true. Although I feel that the natural world holds more wonder than anything that could be thought up by the likes of Sylvia Brown, Deepak Chopra, or Betty Hill, I still daydream about alien crafts landing on the White House lawn or being able to send objects hurling across a room with merely a thought. Just don’t expect a leap of faith when it comes to acceptance of any claim. A good skeptic is open-minded by definition, but as physicist Richard Feynman warned, not so open-minded that their brain falls out.

(1) Nobody is perfect. Even the most staunch of skeptics can have that one compartmentalized woo nugget squirreled away in their oversized cortex. Not me though. And if you don’t believe me, just ask my psychic 10,000 year old Atlantean spirit guide.