From the Bayesian perspective you have a model of the world according to which different treatments have different likelihoods of having effects. Then you pay attention to reality and if reality doesn’t behave in the way your model predicts your model has to be updated. That’s the core of what epistemic rationality is about, being ready to update when your beliefs don’t pay rent.
If you want to go for the maximum of epistemic rationality, write down your credence for the effects of a given treatment down and then check afterwards how good your predictions have been. That’s the way to get a world model that’s aligned with empiric reality.
While doing this it’s worth to keep in mind what you care about. One alternative medicine treatment is for example colon cleaning. People who do colon cleaning usually observe that after taking the colon cleaning substance their shit has a particular surprising form. If you were previously skeptical that the treatment did anything, you shouldn’t take the fact that your shit now has a surprising form that you didn’t expect as evidence that the treatment provides the medical benefits it’s claimed.
There are a bunch of alternative medical intervention that follow the pattern of providing surprising effects which then convince people that the intervention is great while not providing the hoped for benefits.
When thinking about the issue of chiropratic interventions there’s also the question of whether the treated “pelvic misalignment” is the root cause. In the scenario where the “pelvic misalignment” is due to one leg being shorter then the other, it’s plausible that the “pelvic misalignment” is going to happen repeatidly in the future if it gets fixed.
Then if you would for example go every month to get your “pelvic misalignment” from the chiropratic that’s likely better then pain-killers but it’s still not a perfect intervention.
When it comes to working with the body there are a few strains of experts that develop their expertise through trained perception and who mostly work outside of the academia given that the trained expert perception is subjective in nature. I don’t think it’s necessary that those experts are able to translate what they are doing concept that break down along lines that can be objectively observed (like x-ray’s) instead of subjectively accessed.
Just like a good musician might not be able to give you an objective model of his expertise doesn’t mean that they don’t have expertise.
In general it makes sense to go first for the treatments that you think have the most likely success and then if they don’t work depending on how desperate you are down the list to treatments that you believe have a lower chance of success. In practice it makes sense to also factor in what success in a given treatment means, the possible risks of the treatment and the costs.
I took an LW break for a few days and read the abstract of that Cochrane review. I’m going to go paragraph by paragraph in responding, which sometimes looks aggressive on the Internet but is just me crux-hunting.
From the Bayesian perspective you have a model of the world according to which different treatments have different likelihoods of having effects. Then you pay attention to reality and if reality doesn’t behave in the way your model predicts your model has to be updated. That’s the core of what epistemic rationality is about, being ready to update when your beliefs don’t pay rent.
Agreed.
If you want to go for the maximum of epistemic rationality, write down your credence for the effects of a given treatment down and then check afterwards how good your predictions have been. That’s the way to get a world model that’s aligned with empiric reality.
Agreed. I would do this now in advance of another treatment I suspected was woo.
While doing this it’s worth to keep in mind what you care about. One alternative medicine treatment is for example colon cleaning. People who do colon cleaning usually observe that after taking the colon cleaning substance their shit has a particular surprising form. If you were previously skeptical that the treatment did anything, you shouldn’t take the fact that your shit now has a surprising form that you didn’t expect as evidence that the treatment provides the medical benefits it’s claimed.
“Laughing deliriously” is not a result I would have expected from getting my leg tugged on exactly once, but I understand you (above) to be claiming that the unexpected result is evidence that it was not merely a placebo. I’m not a physiologist, but I can’t even begin to think of a reason for leg-tug->delirious-laugh other than “placebo.”
There are a bunch of alternative medical intervention that follow the pattern of providing surprising effects which then convince people that the intervention is great while not providing the hoped for benefits.
This is my understanding as well, and it acts as a global “less likely” coefficient any time I hear any claim made by the alternative medicine community.
When thinking about the issue of chiropratic interventions there’s also the question of whether the treated “pelvic misalignment” is the root cause.
The DO made no claims about what caused the pelvic misalignment (although she speculated that it was because I drive a manual transmission!), only that pelvic misalignment was the cause of the pain.
In the scenario where the “pelvic misalignment” is due to one leg being shorter then the other, it’s plausible that the “pelvic misalignment” is going to happen repeatidly in the future if it gets fixed.
Yes, and grossly/radiographically visible pelvic misalignment is a thing that happens due to legs of different lengths, but you are being too charitable. This DO did not say my legs were different lengths or that the misalignment was grossly visible, and in fact, she claimed that many such misalignments were invisible to x-ray.
Then if you would for example go every month to get your “pelvic misalignment” from the chiropratic that’s likely better then pain-killers but it’s still not a perfect intervention.
In which case I think a “doctor” or practitioner of any stripe has an obligation to dig deeper for an actual root cause. Who stops at, “Very gently tugging on this guy’s leg once a month provides some relief for his back pain that was bad enough that he went to the ER”? I’m not prepared to excuse that level of incuriousness; it causes me to down-update my trust in everything the practitioner says.
When it comes to working with the body there are a few strains of experts that develop their expertise through trained perception and who mostly work outside of the academia given that the trained expert perception is subjective in nature. I don’t think it’s necessary that those experts are able to translate what they are doing concept that break down along lines that can be objectively observed (like x-ray’s) instead of subjectively accessed.
I completely disagree. I would expect what you’re calling subjective trained expert perception to be constantly subject to all of the following cognitive biases (reading the Wikipedia list) and others I haven’t thought of:
Anchoring bias (you learn bullshit in your bullshit school about what causes unilateral back pain, and that’s your frame for all unilateral back pain now)
Availability bias (these other biases cause you to remember confirming data, which then...causes you to remember confirming data)
Confirmation bias (you remember everyone who you helped and forget the people you didn’t help)
Backfire effect (when someone says you didn’t help, you find a way to use that as evidence that your underlying theory is true)
Hindsight bias (when someone has a good result, you believe it was predictable at the time you treated them, which makes you look great in your own mind)
Illusory truth effect/availability cascade (everyone in your professional community says unilateral back pain is caused by pelvic misalignment)
Sunk-cost thinking (you spent a lot of money and professional time learning to tug on people’s legs, so you tend to ignore evidence that your entire field is woo, or decide that “Western medicine” is the real villain)
Pareidolia (you perceive important patterns in random noise—cf. study where practitioners can’t agree on where a supposed trigger point is)
Salience bias (a patient says you cured their back pain vs. a patient who you never see again and posts on the Internet dragging your entire field)
Summing over all these biases, I have basically no faith at all in subjective trained expert perception of people performing chiropractic/bodywork. Crux: Whether there are reliable studies tending to show that such practitioners have any ability to diagnose/recognize illness conditions better than chance, or that their diagnosis-specific chiropractic manipulations do better than the replacement-level intervention we would expect from “Western medicine” treating the same symptom. No partial credit for “You have a C4-C5 subluxation that won’t show up on a CT scan; I prescribe [the same physical therapy you’d get from an MD].”
Just like a good musician might not be able to give you an objective model of his expertise doesn’t mean that they don’t have expertise.
Bodywork-expertise claims to have both objective effects on humans and objective models behind those effects. I don’t think musicians make similarly specific claims (beyond very general things like “these three notes sound weird because the third one is out of key” or “songs in a minor key tend to feel sad relative to songs in the major key”). Musicians and bodyworkers may both claim “expertise through trained perception,” but a musician claiming that is making dramatically weaker factual claims at a dramatically weaker epistemic standard than the bodyworker.
In general it makes sense to go first for the treatments that you think have the most likely success and then if they don’t work depending on how desperate you are down the list to treatments that you believe have a lower chance of success. In practice it makes sense to also factor in what success in a given treatment means, the possible risks of the treatment and the costs.
>If you were previously skeptical that the treatment did anything, you shouldn’t take the fact that your shit now has a surprising form that you didn’t expect as evidence that the treatment provides the medical benefits it’s claimed.
Isn’t this conditional on why you think it would not help? If you believe that is does nothign and therefore doesn’t work then it doing a weird thing should make one less sure of any claims which on the balance ignorant 50:50 would be nearer to it working thhan a strong stand against. Yes it is good to focus on does the weird thing help or hinder but surprise about the mechanism is still surprise.
When it comes to popular treatments there are reasons why other people use those treatments. Generally, other people using a treatment is some evidence that it works. If the other people however use the treatment because it produces big effects in short time frames that have nothing to do with health benefits that means them using the treatment is less evidence that it works.
I do think that in the world we are living there’s a sizeable number of approaches in the New Age / alternative medicine category that share “surprising short term effect” + “doesn’t uphold promises about long term effects” and that it’s useful to warn people about them when you tell them they should be more willing to accept evidence that certain alternative medicine interventions can have positive effects.
From the Bayesian perspective you have a model of the world according to which different treatments have different likelihoods of having effects. Then you pay attention to reality and if reality doesn’t behave in the way your model predicts your model has to be updated. That’s the core of what epistemic rationality is about, being ready to update when your beliefs don’t pay rent.
If you want to go for the maximum of epistemic rationality, write down your credence for the effects of a given treatment down and then check afterwards how good your predictions have been. That’s the way to get a world model that’s aligned with empiric reality.
While doing this it’s worth to keep in mind what you care about. One alternative medicine treatment is for example colon cleaning. People who do colon cleaning usually observe that after taking the colon cleaning substance their shit has a particular surprising form. If you were previously skeptical that the treatment did anything, you shouldn’t take the fact that your shit now has a surprising form that you didn’t expect as evidence that the treatment provides the medical benefits it’s claimed.
There are a bunch of alternative medical intervention that follow the pattern of providing surprising effects which then convince people that the intervention is great while not providing the hoped for benefits.
When thinking about the issue of chiropratic interventions there’s also the question of whether the treated “pelvic misalignment” is the root cause. In the scenario where the “pelvic misalignment” is due to one leg being shorter then the other, it’s plausible that the “pelvic misalignment” is going to happen repeatidly in the future if it gets fixed.
Then if you would for example go every month to get your “pelvic misalignment” from the chiropratic that’s likely better then pain-killers but it’s still not a perfect intervention.
When it comes to working with the body there are a few strains of experts that develop their expertise through trained perception and who mostly work outside of the academia given that the trained expert perception is subjective in nature. I don’t think it’s necessary that those experts are able to translate what they are doing concept that break down along lines that can be objectively observed (like x-ray’s) instead of subjectively accessed.
Just like a good musician might not be able to give you an objective model of his expertise doesn’t mean that they don’t have expertise.
In general it makes sense to go first for the treatments that you think have the most likely success and then if they don’t work depending on how desperate you are down the list to treatments that you believe have a lower chance of success. In practice it makes sense to also factor in what success in a given treatment means, the possible risks of the treatment and the costs.
I took an LW break for a few days and read the abstract of that Cochrane review. I’m going to go paragraph by paragraph in responding, which sometimes looks aggressive on the Internet but is just me crux-hunting.
Agreed.
Agreed. I would do this now in advance of another treatment I suspected was woo.
“Laughing deliriously” is not a result I would have expected from getting my leg tugged on exactly once, but I understand you (above) to be claiming that the unexpected result is evidence that it was not merely a placebo. I’m not a physiologist, but I can’t even begin to think of a reason for leg-tug->delirious-laugh other than “placebo.”
This is my understanding as well, and it acts as a global “less likely” coefficient any time I hear any claim made by the alternative medicine community.
The DO made no claims about what caused the pelvic misalignment (although she speculated that it was because I drive a manual transmission!), only that pelvic misalignment was the cause of the pain.
Yes, and grossly/radiographically visible pelvic misalignment is a thing that happens due to legs of different lengths, but you are being too charitable. This DO did not say my legs were different lengths or that the misalignment was grossly visible, and in fact, she claimed that many such misalignments were invisible to x-ray.
In which case I think a “doctor” or practitioner of any stripe has an obligation to dig deeper for an actual root cause. Who stops at, “Very gently tugging on this guy’s leg once a month provides some relief for his back pain that was bad enough that he went to the ER”? I’m not prepared to excuse that level of incuriousness; it causes me to down-update my trust in everything the practitioner says.
I completely disagree. I would expect what you’re calling subjective trained expert perception to be constantly subject to all of the following cognitive biases (reading the Wikipedia list) and others I haven’t thought of:
Anchoring bias (you learn bullshit in your bullshit school about what causes unilateral back pain, and that’s your frame for all unilateral back pain now)
Availability bias (these other biases cause you to remember confirming data, which then...causes you to remember confirming data)
Confirmation bias (you remember everyone who you helped and forget the people you didn’t help)
Backfire effect (when someone says you didn’t help, you find a way to use that as evidence that your underlying theory is true)
Hindsight bias (when someone has a good result, you believe it was predictable at the time you treated them, which makes you look great in your own mind)
Illusory truth effect/availability cascade (everyone in your professional community says unilateral back pain is caused by pelvic misalignment)
Sunk-cost thinking (you spent a lot of money and professional time learning to tug on people’s legs, so you tend to ignore evidence that your entire field is woo, or decide that “Western medicine” is the real villain)
Pareidolia (you perceive important patterns in random noise—cf. study where practitioners can’t agree on where a supposed trigger point is)
Salience bias (a patient says you cured their back pain vs. a patient who you never see again and posts on the Internet dragging your entire field)
Summing over all these biases, I have basically no faith at all in subjective trained expert perception of people performing chiropractic/bodywork. Crux: Whether there are reliable studies tending to show that such practitioners have any ability to diagnose/recognize illness conditions better than chance, or that their diagnosis-specific chiropractic manipulations do better than the replacement-level intervention we would expect from “Western medicine” treating the same symptom. No partial credit for “You have a C4-C5 subluxation that won’t show up on a CT scan; I prescribe [the same physical therapy you’d get from an MD].”
Bodywork-expertise claims to have both objective effects on humans and objective models behind those effects. I don’t think musicians make similarly specific claims (beyond very general things like “these three notes sound weird because the third one is out of key” or “songs in a minor key tend to feel sad relative to songs in the major key”). Musicians and bodyworkers may both claim “expertise through trained perception,” but a musician claiming that is making dramatically weaker factual claims at a dramatically weaker epistemic standard than the bodyworker.
Agreed.
>If you were previously skeptical that the treatment did anything, you shouldn’t take the fact that your shit now has a surprising form that you didn’t expect as evidence that the treatment provides the medical benefits it’s claimed.
Isn’t this conditional on why you think it would not help? If you believe that is does nothign and therefore doesn’t work then it doing a weird thing should make one less sure of any claims which on the balance ignorant 50:50 would be nearer to it working thhan a strong stand against. Yes it is good to focus on does the weird thing help or hinder but surprise about the mechanism is still surprise.
When it comes to popular treatments there are reasons why other people use those treatments. Generally, other people using a treatment is some evidence that it works. If the other people however use the treatment because it produces big effects in short time frames that have nothing to do with health benefits that means them using the treatment is less evidence that it works.
I do think that in the world we are living there’s a sizeable number of approaches in the New Age / alternative medicine category that share “surprising short term effect” + “doesn’t uphold promises about long term effects” and that it’s useful to warn people about them when you tell them they should be more willing to accept evidence that certain alternative medicine interventions can have positive effects.