Of course, the corollary to the above is that, when we fail, no one blames God for giving the patient the disease that killed them and against which we exercised all our science, skill, and knowledge.
This hits way too close to home for me to find it humorous .... Too many doctors these days rigidly apply population averages to individual patients, then wonder why it doesn't work sometimes. Ugh. I'll write more later when I'm more awake.
And he looks so happy too! Now I finally get it. All this time Carlin was just gunning for the position, badmouthing the big guy like that! That cunning mofo.
I agree with #4. I have and continue to be the victim, if that is the right word, of population averaging. However, in defense of the medicos, they are applying real data to their patients, as flawed as that data may be. The option of so-called "alternative medicine" is not a viable solution. Medical science doesn't have all the answers, but it continues to discover and learn and I would trust a physician's educated guess at a cure based on research over getting poked with hot needles at mystical points on my body determined by the day of the week, drinking water that "remembers", or relying on a Cloud Daddy. My appendix agrees.
I agree with #4. I have and continue to be the victim, if that is the right word, of population averaging.
The promise of genomic and proteinomic medicine is the potential to get us away from being forced to use population averaging as physicians, or at least to allow us to match the population results to the individual much better, ushering in the era of truly personalized medicine. The difference between this personalized medicine and the "personalized medicine" of the woo-pushers is that this new medicine will be based on actual science, epidemiology, genetics, and data, rather than woo.
#4 "Too many doctors these days rigidly apply population averages to individual patients, then wonder why it doesn't work sometimes."
What is the alternative to applying the best available matching data to a patient? Doctors are perfectly aware that all patients are unique; if the treatment doesn't work when it sometimes does, they would generally *love to know why. Why don't you help them out and tell them why it didn't work with a particular patient?
Faith healers and purveyors of pseudo science *never wonder why it didn't work for a particular patient. Not only are they generally uninterested in learning, but they know their magic cures don't work for anybody, altho they'll certainly take credit if the patient lives.
I always think of Steven Jay Gould's response when he got his first cancer diagnosis and the doctor said the average survival time was M months: Gould looked up the distribution and found that a significant number of patients lived Y years after diagnosis.
The people missing the point of #4 may not be aware of various medical realities. One important issue is that sometimes people get better despite medical treatment (the real stuff, not just the fake stuff) rather than because of it (part of that old-fashioned remission and placebo effect) and yet doctors would typically be taking credit in their success figures (as per the cartoon's point) for those cases where in fact they didn't genuinely help, ie contribute more than doing nothing at all would have done. And some medicines are so inappropriate for certain patients that they actively do harm to them (whereas an average "normal" person might benefit).
Unfortunately, SEF's explanation has left me even more confused. Point 1 seems to be that there's such a thing as the placebo effect and that many illnesses have a waxing/waning course whether treated or not. True. That's what randomized placebo controlled trials are for: to avoid error through that bias. But in terms of an individual patient who is being treated off study, how could one even tell for certain what the effect of the med was? If the patient got better, did she/he get better because of or despite the medication? One could, I suppose, do withdrawl and reintroduction experiments, but I'm not sure why that would be a good idea for a patient who is doing well on a well studied medication.
Point 2 is that some medications cause bad reactions in some patients. Also true. Some are predictable, others unpredictable. Any decent doctor will ask their patient about past drug reactions and any conditions that might cause atypical reactions, but beyond that, what are you saying should be done?
If people really (on all levels of their minds) gave credit to God, they wouldn't go back to the physician in the future.
Only a very few trust God so much as to refuse medical treatment. And the rest think those few are idiots.
If you measured Xianity by the numbers who trusted God as much or more than they trust humans and "materialism", this would easily count as a post-Xian society.
It seems to me that this gets back to a post P.Z. did a lot earlier about (roughly) "What has religion ever done to you to make you mad at it?"
As P.Z. pointed out in that post, one of the things religion does routinely is steal the credit. The doc in the cartoon has every right to be mad--when things go wrong he gets the blame, but when things go right, human hard work in medical research and his own hard work in learning to be a doctor get ignored, and the credit gets given to God.
Placebo trial are fine in their place, but they are limited in their use.
For exampke, suppose there is a new treatment for a type of cancer that involved eary surgical intervetion followed by chemotherapy and radiotherapy, and the current treatment is just chemotherapy and radiotherapy. Unless you are willing to anethatise patients, open them up and then close without douing anything it is hard to see how you can test the effectivness of the new treatment. Of course doing that would be rather unethical, since no operation is withour risk.
I think the point is supposed to be "But doctors can't always claim the credit, either"? True, but there's not an overwhelming cultural standard of actually giving doctors credit in the first place. They're not trying for "always" as much as "hey, at least some of the time?"
That's very good advice. You could start with the second part of your quotation from Dianne: "...and that many illnesses have a waxing/waning course whether treated or not."
It's (one of) #4s variations on the cartoon's point - it's the same type of point, ie over who gets unmerited credit. So a correction in the doctor's favour (from giving it all to god) would be an over-correction (away from nature).
Waxing/waning isn't quite the same thing as complete healing/remission though. It would be another aspect to consider before regarding the experiment complete in regard to a final success or failure though, ie at an intermediate position.
A good number of conditions will get better if treated or not, and all treatment does is reduce the severity or longevity of the condition.
However there are also a good number of conditions that are likely to kill you if left untreated. Many cancers come into this category(*) and not many people survive an untreated broken pelvis or femur.
(*) The exceptions tend to be in the elderly where the cancer is very slow growing.
So a correction in the doctor's favour (from giving it all to god) would be an over-correction (away from nature)
Not always. If a doctor cuts a tumor out of my brain, I'd say there's a pretty good chance the remission is from the actions of the doctor rather than nature.
Clifford Shoemaker, the lawyer who attempted to silence and intimidate Kathleen Seidel by asking for every shred of paper she's ever seen in her life, has been sanctioned by the US District Court for the District of New Hampshire. The order is here. It's a strongly-worded order, too:
Shoemaker has not offered a shred of evidence to support his speculations. He has, he says, had his suspicions aroused because she has so much information. Clearly he is unfamiliar with the extent of the information which a highly-competent librarian like Ms. Seidel can, and did, accumulate. If Shoemaker wanted to know if Ms. Seidel was in part supported by or provided information by Bayer, he could have inquired of Bayer or limited the Seidel subpoena to that information. Instead he issued the subpoena calling for production of documents and a deposition on the day before he stipulated to dismiss the underlying suit with prejudice. His failure to withdraw the subpoena when he clearly knew that suit was over is telling about his motives. His efforts to vilify and demean Ms. Seidel are unwarranted and unseemly.
#32
Sorry for the snark (I'm having car trouble this morning) but I do find it odd that you omitted that second part of the sentence. I do think that natural remission is taken into account in research by control groups and double-blind studies. In clinical practice, how can you tell? Some things are easy - you will die without treatment. Some conditions often go into permanent remission (depression is a good example). But there is a statistical advantage to treatment, so this is why it may be mistakenly credited with a cure. But then, how do you know after the fact?
Let's put it this way, SEF: When someone helps to heal a person, it isn't God. It isn't always the doctor, either (they aren't the only effective health professionals), and many time people just get better (actually, physicians not infrequently try to simply maintain health and to treat symptoms until the body heals itself).
Doctors (as users of science) do deserve credit, God does not.
SEF@30. I don't even see that in #4, which is about how doctors uncritically apply population averages to individual patients "then wonder why it doesn't work sometimes". A valid criticism perhaps, but in no way related to taking unearned credit for cures, because in the cases mentioned, there isn't a cure. BlazingDragon@4 implies (s)he is not fully awake - I think (s)he just misread the cartoon.
I was only trying to explain #4 to the people who weren't getting it. Don't mistake me for someone who thinks the medic's/science's actions are never helpful (or that an imaginary god's ever are!).
How about this: If death results while a doctor is operating and litigation is brought against him, then he should counter with the defense that it was not his guiding hand bur the unguiding hand of god that caused the patient's death. I would love to be the lawyer representing the doctor(religious or otherwise) and offer the pernicious defense; "Hey, this god has a hand in everything, so who are you to tell me that the good doctor did not have a god at his side and determine that it wants to bring the patient to heaven? Are you questioning the infallability of this god's hand in determing the outcome of this operation? How dare you to tell me that god was not at my side? And, are you saying that all of us who speak to this god and let it determine the outcome are wrong and batshit crazy? You are questioning my belief in an almighty god who will come down and give you what for? Are you going to tell me that your god is on the prosecutor's side? What, now we have two gods? Your honor, I move we dismiss this case out of lack of sheer evidence!
Damn good point June! Here in Oregon we have years worth of cases of children dieing for gods sake, none of the parents are seen to party at the funerals. Hypocrites!
Curious. There is a pertinent post over at Sciencenotes (http://sciencenotes.wordpress.com/2008/06/30/proper-thanks/#respond) and techskeptic (http://techskeptic.blogspot.com/2008/04/correct-thanking.html)
The idea is to place thanks to the right people, and not just doctors, but engineers, researchers, and everybody who makes it possible to survive what could have been fatal occurences. I would add thanks to those whose work makes life tolerably safe, comfortable, productive and interesting as well. What has Big Hairy Sky Man done (lately)? Has he healed the sick? Installed traffic-control devices? Inspected the food supply? Made me laugh? George Carlin indeed!
Mena@46,
Well, he spends all his time slumped in front of the TV, drinking six-packs and eating junk food - of course he's acquired a pair of man-boobs!
Of course, the corollary to the above is that, when we fail, no one blames God for giving the patient the disease that killed them and against which we exercised all our science, skill, and knowledge.
OK, I'll be the first to say it. So George Carlin finally replaced God?
Obviously the physicians are blinded by the sin of Pride.
This hits way too close to home for me to find it humorous .... Too many doctors these days rigidly apply population averages to individual patients, then wonder why it doesn't work sometimes. Ugh. I'll write more later when I'm more awake.
OK, I'll be the first to say it. So George Carlin finally replaced God?
You beat me to it!!
And he looks so happy too! Now I finally get it. All this time Carlin was just gunning for the position, badmouthing the big guy like that! That cunning mofo.
Thanks for the Links, Paryngulists
Carlin in Hell
with Fred Phelps
also Tim and George in Fred's Hell
misc Carlin rants, also satire by
Barry Crimmins, Will Durst, and others
podcast
I think the world will be much more interesting now.
I agree with #4. I have and continue to be the victim, if that is the right word, of population averaging. However, in defense of the medicos, they are applying real data to their patients, as flawed as that data may be. The option of so-called "alternative medicine" is not a viable solution. Medical science doesn't have all the answers, but it continues to discover and learn and I would trust a physician's educated guess at a cure based on research over getting poked with hot needles at mystical points on my body determined by the day of the week, drinking water that "remembers", or relying on a Cloud Daddy. My appendix agrees.
#4: Huh? True of false, what does your comment have to do with the cartoon?
The promise of genomic and proteinomic medicine is the potential to get us away from being forced to use population averaging as physicians, or at least to allow us to match the population results to the individual much better, ushering in the era of truly personalized medicine. The difference between this personalized medicine and the "personalized medicine" of the woo-pushers is that this new medicine will be based on actual science, epidemiology, genetics, and data, rather than woo.
"When we fail, we get sued..."
Amputating the wrong leg then, would be an example of "failure"? Ummm...well, yeah, I guess it would be, at that.
Never mind :)...
#4 "Too many doctors these days rigidly apply population averages to individual patients, then wonder why it doesn't work sometimes."
What is the alternative to applying the best available matching data to a patient? Doctors are perfectly aware that all patients are unique; if the treatment doesn't work when it sometimes does, they would generally *love to know why. Why don't you help them out and tell them why it didn't work with a particular patient?
Faith healers and purveyors of pseudo science *never wonder why it didn't work for a particular patient. Not only are they generally uninterested in learning, but they know their magic cures don't work for anybody, altho they'll certainly take credit if the patient lives.
I'm relieved to know I'm not the only one scratching my head over this question.
Population statistics--
I always think of Steven Jay Gould's response when he got his first cancer diagnosis and the doctor said the average survival time was M months: Gould looked up the distribution and found that a significant number of patients lived Y years after diagnosis.
. . . And he did, too.
Yours for long positive tails,
Voracious
The people missing the point of #4 may not be aware of various medical realities. One important issue is that sometimes people get better despite medical treatment (the real stuff, not just the fake stuff) rather than because of it (part of that old-fashioned remission and placebo effect) and yet doctors would typically be taking credit in their success figures (as per the cartoon's point) for those cases where in fact they didn't genuinely help, ie contribute more than doing nothing at all would have done. And some medicines are so inappropriate for certain patients that they actively do harm to them (whereas an average "normal" person might benefit).
Unfortunately, SEF's explanation has left me even more confused. Point 1 seems to be that there's such a thing as the placebo effect and that many illnesses have a waxing/waning course whether treated or not. True. That's what randomized placebo controlled trials are for: to avoid error through that bias. But in terms of an individual patient who is being treated off study, how could one even tell for certain what the effect of the med was? If the patient got better, did she/he get better because of or despite the medication? One could, I suppose, do withdrawl and reintroduction experiments, but I'm not sure why that would be a good idea for a patient who is doing well on a well studied medication.
Point 2 is that some medications cause bad reactions in some patients. Also true. Some are predictable, others unpredictable. Any decent doctor will ask their patient about past drug reactions and any conditions that might cause atypical reactions, but beyond that, what are you saying should be done?
And I'm still not sure how this all relates to a cartoon about suing god for refusing to act on prayers from faith healers.
If people really (on all levels of their minds) gave credit to God, they wouldn't go back to the physician in the future.
Only a very few trust God so much as to refuse medical treatment. And the rest think those few are idiots.
If you measured Xianity by the numbers who trusted God as much or more than they trust humans and "materialism", this would easily count as a post-Xian society.
Glen Davidson
http://tinyurl.com/2kxyc7
Hasn't it has already been established that not only does prayer not work but being prayed for is detrimental to your chances of recovery.
What the medical people need to do is get patients to sign some sort of agreement that, whilst in their care, they are not receiving supernatural aid.
Faith healers < Doctors
Great post, PZ.
You've skipped the very important natural remission component. Read the words - all of them. Then think about them too.
If a patient was going to get better anyway, doctors (just like the imaginary friend) would still be getting the credit for something they didn't do.
It seems to me that this gets back to a post P.Z. did a lot earlier about (roughly) "What has religion ever done to you to make you mad at it?"
As P.Z. pointed out in that post, one of the things religion does routinely is steal the credit. The doc in the cartoon has every right to be mad--when things go wrong he gets the blame, but when things go right, human hard work in medical research and his own hard work in learning to be a doctor get ignored, and the credit gets given to God.
Guys, click on the picture and read the whole cartoon. It will make a lot more sense!
Also, thanks for posting that picture, PZ! I'm sure Matt Bors will be glad for the extra attention.
Dianne,
Placebo trial are fine in their place, but they are limited in their use.
For exampke, suppose there is a new treatment for a type of cancer that involved eary surgical intervetion followed by chemotherapy and radiotherapy, and the current treatment is just chemotherapy and radiotherapy. Unless you are willing to anethatise patients, open them up and then close without douing anything it is hard to see how you can test the effectivness of the new treatment. Of course doing that would be rather unethical, since no operation is withour risk.
doctors would typically be taking credit in their success figures (as per the cartoon's point) - SEF
But that's not the cartoon's point!
I think the point is supposed to be "But doctors can't always claim the credit, either"? True, but there's not an overwhelming cultural standard of actually giving doctors credit in the first place. They're not trying for "always" as much as "hey, at least some of the time?"
SEF sez: Read the words - all of them.
That's very good advice. You could start with the second part of your quotation from Dianne: "...and that many illnesses have a waxing/waning course whether treated or not."
Quote mine, anyone?
(.)(.)
It's (one of) #4s variations on the cartoon's point - it's the same type of point, ie over who gets unmerited credit. So a correction in the doctor's favour (from giving it all to god) would be an over-correction (away from nature).
Ah. The return of wÒÓ†.
@ #28
Waxing/waning isn't quite the same thing as complete healing/remission though. It would be another aspect to consider before regarding the experiment complete in regard to a final success or failure though, ie at an intermediate position.
A good number of conditions will get better if treated or not, and all treatment does is reduce the severity or longevity of the condition.
However there are also a good number of conditions that are likely to kill you if left untreated. Many cancers come into this category(*) and not many people survive an untreated broken pelvis or femur.
(*) The exceptions tend to be in the elderly where the cancer is very slow growing.
So a correction in the doctor's favour (from giving it all to god) would be an over-correction (away from nature)
Not always. If a doctor cuts a tumor out of my brain, I'd say there's a pretty good chance the remission is from the actions of the doctor rather than nature.
Unrelated:
Clifford Shoemaker, the lawyer who attempted to silence and intimidate Kathleen Seidel by asking for every shred of paper she's ever seen in her life, has been sanctioned by the US District Court for the District of New Hampshire. The order is here. It's a strongly-worded order, too:
#32
Sorry for the snark (I'm having car trouble this morning) but I do find it odd that you omitted that second part of the sentence. I do think that natural remission is taken into account in research by control groups and double-blind studies. In clinical practice, how can you tell? Some things are easy - you will die without treatment. Some conditions often go into permanent remission (depression is a good example). But there is a statistical advantage to treatment, so this is why it may be mistakenly credited with a cure. But then, how do you know after the fact?
Let's put it this way, SEF: When someone helps to heal a person, it isn't God. It isn't always the doctor, either (they aren't the only effective health professionals), and many time people just get better (actually, physicians not infrequently try to simply maintain health and to treat symptoms until the body heals itself).
Doctors (as users of science) do deserve credit, God does not.
Glen D
http://tinyurl.com/2kxyc7
SEF@30. I don't even see that in #4, which is about how doctors uncritically apply population averages to individual patients "then wonder why it doesn't work sometimes". A valid criticism perhaps, but in no way related to taking unearned credit for cures, because in the cases mentioned, there isn't a cure. BlazingDragon@4 implies (s)he is not fully awake - I think (s)he just misread the cartoon.
@ #34, #36, 37
I was only trying to explain #4 to the people who weren't getting it. Don't mistake me for someone who thinks the medic's/science's actions are never helpful (or that an imaginary god's ever are!).
How about this: If death results while a doctor is operating and litigation is brought against him, then he should counter with the defense that it was not his guiding hand bur the unguiding hand of god that caused the patient's death. I would love to be the lawyer representing the doctor(religious or otherwise) and offer the pernicious defense; "Hey, this god has a hand in everything, so who are you to tell me that the good doctor did not have a god at his side and determine that it wants to bring the patient to heaven? Are you questioning the infallability of this god's hand in determing the outcome of this operation? How dare you to tell me that god was not at my side? And, are you saying that all of us who speak to this god and let it determine the outcome are wrong and batshit crazy? You are questioning my belief in an almighty god who will come down and give you what for? Are you going to tell me that your god is on the prosecutor's side? What, now we have two gods? Your honor, I move we dismiss this case out of lack of sheer evidence!
The Christian faith teaches that, when a child dies, God is taking it to Heaven to be with Him forever. This is a goal that all Christians strive for.
Why, then, is there so little celebrating and rejoicing when a child dies in a Christian family?
Damn good point June! Here in Oregon we have years worth of cases of children dieing for gods sake, none of the parents are seen to party at the funerals. Hypocrites!
Yay! w00+ is back!
Curious. There is a pertinent post over at Sciencenotes (http://sciencenotes.wordpress.com/2008/06/30/proper-thanks/#respond) and techskeptic (http://techskeptic.blogspot.com/2008/04/correct-thanking.html)
The idea is to place thanks to the right people, and not just doctors, but engineers, researchers, and everybody who makes it possible to survive what could have been fatal occurences. I would add thanks to those whose work makes life tolerably safe, comfortable, productive and interesting as well. What has Big Hairy Sky Man done (lately)? Has he healed the sick? Installed traffic-control devices? Inspected the food supply? Made me laugh? George Carlin indeed!
WOO @ 29 Ah, the Blue Footed Booby! I'm glad they are not related to the creotard boobies!
Speaking of Woot, why does the cartoon god have, well, boobies?
Mena@46,
Well, he spends all his time slumped in front of the TV, drinking six-packs and eating junk food - of course he's acquired a pair of man-boobs!
Matt Bors is a great cartoonist, IMHO. Frequenters of Dawkins' website might remember this little gem:
http://www.mattbors.com/2007/12/world-history.html