White Coat Underground

Fear the clowns

As I sit in my (very narrow) seat on a DC-9 heading for North Carolina, one thing in particular strikes me: I’m really, really pleased that there is no such thing as “alternative engineering”. It’s not that “allopathic” or “mainstream” engineers never make mistakes—bridges collapse, cars break, computers die—but most of the time, our buildings, tools, and machines work. In fact, they work so well that we rarely think about all the work that has gone into creating them. Still, even when our houses fall down or our toys break, we don’t go running for a “new kind” of engineering. We send professionals back to the drawing board and, using an understanding of the physical world, they try to redesign things in a better way. Planes have crashed due to ice accumulation. This morning, they de-iced my plane, and I’m not complaining about the delay. Engineers learn from bad outcomes.

Medicine is a somewhat softer science than engineering, at least in some ways. You can’t, for example, subject people to conditions that push the tolerance of the human machine to its limit in order to see what it takes to break one. There are ethics governing the study of human medicine that are largely irrelevant in engineering.

Complicating the study of medicine further is an odd phenomenon. We feel we have some sort of “special knowledge” of the human machine—we each own one, and are intimately associated with it (if you’ll excuse the dualist phrasing). Despite the fact that the human body is immensely complex, it is tempting to think that as the owner of one, we understand its workings better than we do. There is an intimacy that we simply can’t replicate with, for example, a highway overpass.

These two facts are the good friends of quacks, charlatans, and other clowns. Perhaps because of the special relationship we have with the human machine, people tend to think that intuition is a guide to its function in a way they would never presume to assert when, say, building a bridge. For some reason, we tend to think that with human health, there are “other ways of knowing” than science (or more properly, perhaps, methodological naturalism). A good deal of this is due to our naturally dualist tendencies. We often tend to think of “self” as being something separate from the sack of meat that comprises all we are. Since in a dualist view, no one can point to a “self”, no one can measure it or manipulate it physically, we are left with superstition rather than science when trying to describe it.

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Now, I’m obviously not advocating this view; I’m simply describing it. When we get back to the fact that “self” or “soul” is an epiphenomenon of brain, things are a bit simpler, but also more constrained (i.e., by natural laws). Being a mind-body dualist allows one to dispense with all sorts of pesky natural constraints. Since airplanes don’t have souls, I don’t need an “alternative engineer”. Since people do have souls (sic), well, call in the clowns.

Are you a little scared of clowns? You should be. There are clowns who approach the science of human medicine differently than other sciences, and basically make it up as they go along. Once you accept mind-body dualism, you can accept mysterious body energy fields, water memory, and subluxations. We don’t let engineers abandon science in favor of intuition. Why should we let doctors?

Comments

  1. #1 Jim
    January 15, 2009

    Very well said, and congrats on your own blog-home.

  2. #2 Dianne
    January 15, 2009

    You weren’t taking US Air from NY to NC today were you? Not the best demonstration of the safety of flying but a good demonstration of the advantages of flotation devices and other such “unnatural” technology.

  3. #3 Skeptico
    January 15, 2009

    I’m really, really pleased that there is no such thing as “alternative engineering”.

    Alternative Engineering

  4. #4 PalMD
    January 15, 2009

    I wrote this on an airplane to NC, and when i landed i got several calls asking if i was perhaps swimming in the hudson…despite the fact that i didn’t fly out of LaG or to Charlotte. Still, I’m glad people care.

  5. #5 HCN
    January 16, 2009

    Dianne, I would also say that was some very good flying by the pilot, or “gliding” as the case may be. He hit the river in such a way that it was a controlled impact into the water so that the plane was able to float, and not break up.

    Engineering failures do make interesting reading, because with those there are changes made to help prevent them from happening again. One good one is the first Tacoma Narrows Bridge, dubbed “Galloping Gertie”:
    http://en.wikipedia.org/wiki/Tacoma_Narrows_Bridge_Collapse

    This even opened up an entire field of engineering, dynamics and loads (which was my specialty, I used to be very good at solving multidimensional nonlinear second order differential equations).

    This does also happen in medicine. Failures can help further the field, or even mistakes that make things better. You just have to have an open mind to realize what is real and what is a clown. Brought to mind as I listened to Dr. Lipson’s podcast where he mentioned heart medication, and I just ordered a refill of my 20 year old son’s beta blockers for his hypertrophic cardiomyopathy.

    Yay for changes in medicine! Because my son’s heart condition was discovered after the family doctor heard a heart murmur during the visit where he got his 14 year old tetanus booster. An echocardiogram was ordered and the abnormal heart anatomy was discovered. All during the same week where in the news were reports of a young lady just a year younger than him who had the same condition, but it was only found after an autopsy from her sudden death.

  6. #6 Lassi Hippeläinen
    January 16, 2009

    You can’t, for example, subject people to conditions that push the tolerance of the human machine to its limit in order to see what it takes to break one. There are ethics governing the study of human medicine that are largely irrelevant in engineering.

    Also engineers have cases when testing by breaking isn’t an option, e.g. when building bridges. There is a whole subfield of engineering called “non-destructive testing”. The motivation may be economics rather than ethics, but the result is the same.

  7. #7 Cannonball Jones
    January 16, 2009

    There’s no excuse for anyone working in medicine to entertain dualistic notions but I still appreciate that it’s a very hard intuition to overcome. Indeed I still catch myself thinking in dualistic terms relatively often and only recently realised (just before the debate opened up on SB) how incredibly wrong I was on the issue of psychological vs physical addiction to drugs.

    Nice post and nice new home :)

  8. #8 Dianne
    January 16, 2009

    HCN: I agree–the pilot’s landing was stellar. Controlled flight onto a river. It also helped that he landed right in front of a ferry terminal and so there were boats to take people out of the freezing water right away. A good pilot, lucky circumstances, and a quick response from the people on the ground (water), but still it would all have been useless if the plane hadn’t been well built enough to survive the abrupt loss of both engines (at least as far as turning into a glider instead of a brick), be able to land on water (presumably without the wheels down), and float for some time (not sure if that was intentional design or just that it is a light cylinder full of air, but it did float for several hours…last I heard it was tied up down by Battery Park City). So it was really everyone: the engineers, the pilot, the bystanders, the flight attendants, the passengers themselves (who evacuated rather than losing their heads and panicing) who contributed to the good outcome.

    In general, I like the way that aviation failures have a “prevent recurrence” model rather than a “blame” model for dealing with disaster. I wish medicine were more like that. Certainly there are attempts to change the model–safety review committees, etc., but there is still a strong tendency to look for someone to blame when a bad outcome occurs in medicine, rather than looking for ways to prevent the same from occuring in the future. Which, of course, doesn’t really help in the end unless the problem truly is one or several incompetent or careless people causing the problem. (Which can happen but systematic failure is more common…and a properly built system can change a disasterous mistake to a minor one. For example, an automated notification system to let doctors, nurses, and pharmacists know if they order a medication that the patient is allergic to changes the mistake from one that might kill someone to “oops, that was dumb…here, I’ll just fix that”.)

  9. #9 ctenotrish
    January 16, 2009

    Great post! I’ll miss you on denialism, but am happy you have your own corner of blog-dom back. Best wishes!

  10. #10 Ramel
    January 17, 2009

    Sadly there is psuedo-science and quackery in engineering, things like perpetual motion machines, magnets for your car to “increase fuel efficency” and folks selling plans for dodgy personal jet packs on the internet. It seems nowhere is safe from teh stupid.

    PAL
    “There are clowns who approach the science of human medicine differently than other sciences, and basically make it up as they go along.”
    We get a few of those as well, such as the idiot who modifide his Land Rover and had different sized brake discs on his fron wheels, so when he put the brakes on hard he span out and killed two of his own kids.

    Lassi Hippeläinen
    “Also engineers have cases when testing by breaking isn’t an option, e.g. when building bridges. There is a whole subfield of engineering called “non-destructive testing”. The motivation may be economics rather than ethics, but the result is the same.”

    The main purpose of non-destructive testing is to test critical components. Things like major structural supports in air craft need to be individually tested to be sure they are fit for purpose, destructive testing would make the part unusable. Many non-destructive testing methods are actually more expensive, and take more time and effort, than destructive methods as they require things like x-ray machines and ultra sound equipment.