The end of ignorance

The folks at whoring for some link love sent me an interesting link. They had a talking heads session (“diavlog”—damn, that’s hard to say) between John Horgan and some other guy (sorry, “Some Other Guy”). Horgan is the guy who brought us The End of Science, a book which was more widely criticized than read. I haven’t read it either, but after watching him, I think I need to do a little reading. He’s a bright guy, and interesting to listen to, but as live chats often go, there were some errors that deserve parsing, not just because they are errors of fact, but because they reveal a certain disappointing line of thought.

In one segment, Horgan and Other Guy are discussing “the limits of medicine”. This bit was disappointing for a number of reasons. Horgan pointed out that medicine had discovered much about Lyme disease in the last few decades, but then said that there are “certain areas where they just seem to be…inadequate to the task.”

Some of this is Horgan’s same old theme of “science: been there, done that.” But there are some pretty important problems here.

First, he defined a problem incorrectly. The problem is not that doctors haven’t figured out how to treat “chronic Lyme disease“, it’s that we haven’t figured out how to deal with patients who think they have it. As Horgan points out, the evidence is clear that there is no role for long-term antibiotics in so-called “chronic Lyme”. The critical appraisal he left out is whether or not such a condition exists.

The second error he makes is in saying that medicine is somehow “not up to the task”. He praises science for discovering Borrelia, and a minute later says that we’ve hit an unsurmountable barrier. If we are at “the limits of medicine”, how do we know? What will replace it? This is a very troubling assertion.

Science-based medicine has ways of dealing with problems. Problems are defined and quantified. Operational definitions are developed, diagnostic tests evaluated, and interventions developed and tested. Is there a disease where this model can’t work? Does a negative answer (“treatment ‘x’ doesn’t work”) mean that our methodology is wrong?

In fact, negative results validate our methods. Negative results are perhaps even more important than positive ones. Science-based medicine is willing to abandon failed hypotheses, something you never see happen in “alternative” cult medicine.

Horgan eventually dives into the “limits” of psychiatric care. He bemoans “shock therapy” (sic) and speaks of psychiatry being a “shadow world” where there are “no good treatments…no cures”.

This is simply an argument from ignorance. The fact that he does not understand psychiatry does not mean that it is a failure. We have many good evidence-based interventions in psychiatry, and obviously a long way to go. Some of our problems are societal—psychiatric (brain) care and research is not funded as well as other treatment of other bits of the body. Illnesses of the mind are more difficult, but that doesn’t mean we should abandon science as a way of learning about and treating them. What is the alternative?

I wonder sometimes about folks who lack the imagination to see the way forward. It is curious how someone can, in one moment, praise the advances of science, and in the next say that science is no longer adequate for understanding reality.

Or is he saying we already know everything? In that case, it’s time to share.