Yesterday was a very strange day, at least on the Internet.
I really should learn to remove Twitter from my iPhone on Wednesdays. Why? Wednesdays tend to be my administrative days. I’m not in clinic seeing patients nor am I in the operating room. That’s why Wednesday tends to be one of the two days a week when I write grants, do administrative work, and meet with my lab people, among other miscellaneous tasks, such as working on upcoming presentations. So I tend to spend most of the day on Wednesdays sitting in front of my computer, and I’m easily distracted by Twitter or other things going on. Normally I can turn focus on what I have to do, but not yesterday (probably due to burnout after having submitted a major grant the day before), which is why things erupted more than they should have.
Yesterday’s post was about news stories portraying Gordie Howe’s “miraculous” recovery from his serious stroke last fall and further attributing his recovery to a dubious stem cell treatment he received at Clinica Santa Clarita in Tijuana, a clinic that uses Novastem stem cells, which are purchased from a company called Stemedica. It was basically a continuation of a post a month before, except that I complained about the credulous news coverage that basically let Stemedica the media as infomercials for their products. In particular I was harshly critical of Keith Olbermann, whose five minute segment two weeks ago on Howe’s recovery was, indeed, basically an infomercial for Stemedica. On a whim, I Tweeted out the link, plus a link to the previous post, to Keith Olbermann (@KeithOlbermann) and the local news station (@Local4News) that did a similar story on Tuesday night featuring new video of Howe.
Let’s just say, Olbermann was not pleased:
— Keith Olbermann (@KeithOlbermann) February 4, 2015
Things degenerated from there.
I was tempted to write up a post about Olbermann, his thin skin, how he blocked anyone who defended the post or criticized his coverage of the Gordie Howe story, or, I guess, just annoyed him, and how he was utterly incapable of admitting that he might have erred. However, I realized that that’s not really the “teachable moment” here. Sure, Olbermann thought I would be “pissed off” by an update he plans on doing Friday, but in reality there would be nothing to be upset about unless he plans on attacking me and misrepresenting what I said, which, I suspect, is the case. Whatever. No, what’s more important is that Olbermann’s reaction serves as an excellent example to illustrate the difference between scientific skepticism and how the vast majority of human beings actually think. I’ve written posts about How “They” View “Us,” not once but multiple times, but those posts were about true believers in woo. Think of this post as an entry in the series about How “They” View “Us,” with the “us” this time being about the rest of the world, neither the true believers nor skeptics, but rather the vast swath of humanity in between. My impetus for this post came from two statements.
First, there is these Tweets from Olbermann, which are representative of several Tweets saying more or less the same thing:
Your conclusion, @gorskon requires that your diagnosis of a patient you've never met, is correct; that one by his son, a physician, is wrong
— Keith Olbermann (@KeithOlbermann) February 4, 2015
This, @gorskon is the worst kind of dilettantism. Allow for the possibility that a medically trained witness might know more than a BLOGGER
— Keith Olbermann (@KeithOlbermann) February 4, 2015
And then there was this comment from SamE from Ohio:
I consider myself a fair- minded person and I usually never comment on articles or get involved in Twitter fights, but something about this tripped my trigger. I came to this article thinking Olbermann was being an arrogant jerk, but after reading it I changed my opinion. I think you’re on firm ground criticizing the company, but not on firm ground speculating on Mr Howe’s true medical condition and the opinion of his son who is a medical doctor.
I agree that this company seems super sketchy and exorbitantly expensive, but that does not mean Mr. Howe did not benefit from their treatment. No one who hasn’t examined Mr Howe can know for sure how the treatments effected him or the true state of his health or whether his family and doctors are exaggerating his recovery. I fail to see why Mr Howe’s son, who is a doctor, would make false claims if his father was really doing poorly and he had been fleeced by quacks.
And there you have it: This is how most people think and why this is about far more than the petulant reaction of a single sports pundit to having his story questioned. In this, Olbermann is being human and demonstrating one of the biggest impediments we humans have to properly determining causation in health matters. Specifically, people are pattern-forming animals. Our first reaction upon seeing correlation is to impute causation to it. We humans also tend to value personal stories and testimonials over scientific evidence—and not by a small margin, either. In a trial, the convincing testimony of a single witness can trump mountains of scientific evidence, even though it’s been shown time and time again how fallible memory is, something that we’ve just been reminded of yet again by Brian Williams. Also, because we are social animals and like to hear stories of people doing well, we tend not to react favorably to any questioning of “miracle cure” testimonials, tending to view such analysis not as reasonable skepticism, but rather as attacks on the person giving the testimonials or as wishing ill on the person who is being presented as having undergone a “miraculous” recovery. I’ve seen this myself so many times when examining the testimonials of, for example, “miracle cancer cures” (in particular of patients of Stanislaw Burzynski). The same is true of the stories of antivaccine activists about how vaccines caused their child’s autism or how this or that quack treatment cured their child’s autism (i.e., “recovered” their child).
We also see this phenomenon at work in the reactions to my discussions of Gordie Howe’s recovery from stroke. Olbermann, for instance, completely ignores all of my other criticisms and observations in my two posts, specifically of his coverage and its kissing up to Maynard Howe, CEO of Stemedica, the dubious involvement of Stemedica in Howe’s care, and how Novastem charges $20,000+ a pop to desperate patients for its unproven stem cell therapy, putting them on clinical trials in a manner not unlike that of Stanislaw Burzynski. (At least SamE acknowledged these, but he still focused like a laser on my questioning of Dr. Howe’s interpretation of what stem cells did for his father.) Instead, Olbermann zeroes in like the proverbial laser on my questioning of Dr. Howe’s account of his father’s progress, portraying it as being the “speculation” of some “BLOGGER” (yes, his Tweets drip with contempt for bloggers) versus that of a “medically trained witness,” a doctor, who’s been caring for his father since his massive stroke in October. In this, Olbermann misses the key message, repeated multiple times in both posts and hammered home at the conclusion of yesterday’s post:
Let no one doubt that I hope Howe’s condition is improved. I just doubt that it was the stem cells that were responsible for his improvement and have a lot of questions and concerns about Novastem’s treatments and clinical trials, concerns I deem well-justified.
Of course Howe’s condition has improved. That’s the normal course of recovery after a stroke: Improvement over several months until a plateau is reached, after which no more improvement occurs. After Gordie Howe survived his last health scare in early December, when he was admitted for severe dehydration, most neurologists would expect him to continue to improve, and it’s great that he apparently has improved to the point where he can stand and play floor hockey with his grandson. What I questioned (and continue to question) is whether the stem cells were responsible, and I laid out many reasons why. Similarly, what I also question is Stemedica and Novastem’s business practices marketing the clinical trials and the credulous coverage of “Gordie Howe’s ‘miracle’ recovery” by not just Olbermann, but by virtually every other reporter who covered the story, with few exceptions.
But, no, Olbermann focused on making it my “speculation” versus Murray Howe’s medically trained knowledge. Why is this? Is Olbermann being dishonest? He might be being a dick, so to speak, in terms of his behavior on Twitter, but in reality his way of thinking is the way that most human beings think. It is the default. And, physician or no, so is Murray Howe’s rapid willingness to let hope take over and to believe strongly that the stem cells are responsible for how well his father is doing. As I like to put it, contrary to how it will likely be portrayed, should Olbermann attack me on Friday, I am not questioning Howe’s assessment that his father is better medically (no doubt he is, as that’s what generally happens more than three months after a stroke), I am questioning Dr. Howe’s conclusion that it was the stem cells that resulted in his father’s improvement, because, as I’ve learned over the last decade, single anecdotes can mislead, even cancer cure anecdotes in which patients with terminal cancer are presented as having been cured of their cancer by this or that alternative therapy. That is what the vast majority of people out there do not understand, including SamE, Olbermann, any number of Stanislaw Burzynski fans, and antivaccinationist.
Indeed, Olbermann’s reaction is really no different than the reaction of antivaccine advocates who swear that their child became autistic as a result of this vaccine or that vaccine. They saw, dammit, and that’s an incredibly powerful narrative to us social, pattern-forming human beings. Just as most “average” people become at least a little uncomfortable when skeptics question mothers’s stories about their children and tend to frame such questioning as an attack on the mother’s story, and therefore her character, such questioning, at least in the minds of most people, implies that the skeptic is accusing the mother of being stupid, wrong, or lying. In Olbermann’s case, add to that that the son giving the testimonial is a physician (we really haven’t heard much from other members of Gordie Howe’s family about this over the last three months), and the testimonial is not to be doubted:
@LTock Because what would a trained physician familiar with all of his father's problems and treatments know about separating those points?
— Keith Olbermann (@KeithOlbermann) February 5, 2015
Again, it doesn’t matter how much the skeptic emphasizes that that he is not accusing anyone or attacking anyone. It doesn’t matter how much the skeptic explains that all people are prone to confuse correlation with causation and all people have memories beset by problems like confirmation bias (where we tend to remember what confirms our preexisting beliefs and to forget what does not), changes in memory that occur based on events that follow the event being recounted, and, of course, emotional investment with the subject. When I hear people say that no one knows her child as well as her mother, that might be true for some things, but it doesn’t apply to medicine or determining if a treatment has worked for a condition as complex as, say, autism. Yet stating that simple observation is sacrilegious.
As for Murray Howe, no one doubts that he loves his father intensely, that he agonized over the decision to take him to Novastem, and that he really believes his father’s improvement is due to stem cells. Who knows? He might be right. On the other hand, given what we know about stem cell treatments for stroke thus far, it’s highly likely that he is doing what so many other people do and confusing correlation with causation. Also, as I well know, having made such mistakes myself, it is very perilous for a physician to treat a close family member—or even to make medical judgments about him. I’ve recounted (vaguely) that I once came to a very wrong conclusion about a new complaint of a close family member before, a conclusion that I doubt I would have made had she not been a close family member. Physicians tend to overestimate their level of objectivity and knowledge. Also, it is not a slam on Dr. Howe to point out that he is a radiologist, not a neurologist. Radiologists don’t take long term care of stroke patients. Most don’t even take care of patients in the same way a primary care doctor does. Radiology is a specialty that involves reading and interpreting images and doing procedures guided by various imaging technologies, such as CT- or ultrasound-guided biopsies or angiography.
In the end, although some aspects of science come naturally to humans, such as the curiosity that leads to scientific discovery and the testing of ideas against reality, scientific skepticism is difficult because it’s not the default manner of thinking in humans. Rather, our default is to assume causation from correlation and to believe the accounts of events by people we like and/or trust, such as Gordie Howe’s family (because we love Gordie Howe), doctors, mothers of children with neurodevelopmental disorders, and patients with life-threatening cancer and their families. We have to learn—and internalize—knowledge that correlation more often than not does not equal causation in medical matters and that because of that people—even physicians—are often wrong when they impute causation to correlation. We have to learn—and internalize—the uncomfortable message that people’s accounts of what they’ve observed are often not good evidence that their interpretation of events (e.g., stem cells resulted in Gordie Howe’s “miraculous recovery”) is correct because memory is affected by so many factors that can interfere with such conclusions. We have to learn—and internalize—the message that questioning such stories is not the same thing as attacking the messenger or accusing him or her of lying, that rather even people we love and admire can be very, very wrong when trying to assess whether an intervention has helped a patient. If these things weren’t true, we wouldn’t need science. We wouldn’t need clinical trials. But we do need them.
One can only hope that Keith Olbermann learns and internalizes these uncomfortable messages, but I doubt he will. He appears to see me (and other skeptics) as buzzkills who think we’re better than, for example, Murray Howe and that we’re wishing ill on Gordie Howe and his family, as “clowns,” “pedants,” and “dilettantes” worthy of his scorn. He even views me as a physician who doesn’t care about alleviating pain in patients, a false dichotomy if ever there was one: You either embrace Stemedica’s and the Howe family’s account of how well its stem cells work or you clearly don’t care about patient suffering. Have we heard this false dichotomy before? I have. I’ve heard it time and time again over Burzynski patient cancer cure stories and “miracle cures” due to “autism biomed.” It’s a feature, not a bug, in human thought, and it’s how we skeptics, no matter how hard we try to avoid it, are often viewed by “regular people.” Keith Olbermann is nothing but this normal human tendency on steroids, wedded to a thin-skinned, very unpleasant personality. We’ve seen this before, too.