Over- and under-assertion

From Why are medical journals full of fashionable nonsense? by Alex Berezow.  One might extend the sentiment of the headline to Why are journalists, academics, public intellectuals, and public officials full of fashionable nonsense but I suspect there is some breaching of the guideline of brevity.  His key points are:

Medical journals are increasingly and dangerously kowtowing to academia’s political zeitgeist. 

From manipulating public health data to using Orwellian language, the publication of “fashionable nonsense” has contributed to a credibility crisis.

If the public comes to believe that it cannot trust medical journals on the easy stuff, then why would we expect people to trust them on anything?

I agree.  High productivity economies depend on high trust and the more there is a breach between the public and our public institutions, be it academia, education, government, mainstream media, etc. the more dangerous it is and the less able we are able to solve real problems rather than imagined ones.  

Just as with Stuart Ritchie in Scientific Fictions, Berezow uses factual examples to illustrate his case.

Berezow offers a succinct example from the Climate Change ideology.  An ideology once committed to the idea that all climate warming is due solely to human activities rather than acknowledging that climate always changes and that while we are probably contributing to those changes, we are not clear how we are doing so (which is the more dominant effect, land use practices or CO2?) nor do we yet know to what degree.

The point is that hopping aboard a political bandwagon is good for grabbing attention — and subsequently, funding. We are witnessing a similar phenomenon with respect to climate change. No matter how extraneous a topic, researchers try to tie it to climate change. Job-stealing robots? Climate change. Resurrecting the woolly mammoth? Climate change. Cancer therapy? Climate change. What could climate change possibly have to do with cancer? The latter article provides one example: “[P]eople with locally advanced non-small cell lung cancer [a]re more likely to die if their radiation therapy [i]s interrupted by hurricanes.”

It is within this dubious milieu — where any outlandish link to climate change is simply assumed to be scientifically legitimate — that the New England Journal of Medicine recently published a perspective on the importance of “decarbonizing” the healthcare sector. The opening sentence makes a bold claim: “​​Nowhere are the effects of climate change manifesting more clearly than in human health.” Really? One might argue that satellite images showing melting ice caps and retreating glaciers are a lot clearer than that — or perhaps the notable increase in the temperature of the planet, or record-breaking heat waves. 

While that first statement could be dismissed as poetically hyperbolic, the article’s second sentence cannot be: “Although many people consider climate change a looming threat, health problems stemming from it already kill millions of people per year.” This claim represents a semi-measurable quantity and is either true or false. The authors cited this paper to support their claim, but it appears that none of them comprehended it. 

The cited research says that, on average from 2000 to 2019, there were about five million excess deaths per year due to “non-optimal temperatures,” 90 percent of which were due to the cold but only 10 percent due to heat. Furthermore, as the temperature rises, more people have been surviving the extreme cold than have been dying from the extreme heat such that there was a net decline in temperature-related deaths. The cited paper not only fails to support the authors’ claim but actually contradicts it.

As it turns out, another source the authors cited contradicted their claim. According to the World Health Organization, “Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhea and heat stress.” Another paper in Nature Climate Change (not cited by the authors) concluded, “[O]ur overall estimate that heat exposure from human-induced climate change is responsible for ~0.6% of total warm-season deaths would translate to more than a hundred thousand deaths per year if applied globally.”

In other words, the authors’ extraordinary claim that “millions of people” are dying right now from climate change is exaggerated at least by a factor of ten.

 While I agree with Berezow on the main points, he also illustrates that maybe the issue is less about ideology per se, even though that is how it usually manifests, but more, perhaps, about behavior, specifically overconfidence and inattention to detail.

Berezow is angry with the more fraudulent movements but his sympathy towards others leads to debatable statements such as:

On September 25 of this year, The Lancet published an issue that rightfully sought to bring attention to women’s health, a topic that has a long and inglorious past due to the fact that, for millennia, medicine has been dominated by men. 

I'd be reasonably comfortable were the claim that women have been overlooked over the past 250-350 years of modern Age of Enlightenment medicine and largely in Europe.   Even that might not bare too close an examination given the past fifty years of focus on women.  

The is a recapitulation of the genetic fallacy, mentioned just a couple of days ago.  Simply because the early modern medical field was initially dominated by men introduces no evidence to the outcomes of their research.  

However, "for millennia" seems too strong a claim.  The most distinct health aspect of women has to do with childbirth and in most places at most times, this has been dominated by women.  The nature of the knowledge developed over millennia could be surprisingly insightful but rarely captured as indeed with the case for most "natural" health treatments.

It is only in the modern era when there has been a clear domination of men in the health treatment of women.  To me, the classic example is puerperal fever which could have a fatality rate of 25-30% under normal conditions and as high as 90% in particular circumstances.  Circumstances such as high volume Laying In hospitals in crowded cities.  Such hospitals only began to exist in 1800s.  

From the beginning male scientists were eager to solve the problem of puerperal fever (see here and here for some detail).  Dr. Ignaz Semmelweis in Vienna, Austria, after three years of experience and observation in Vienna's main maternity clinic advanced the theory that puerperal fever was spread from patient to patient via unclean hands and instruments.  His solution was a regimen of rigorous cleansing and it was effective.

However, his observational recommendations did not receive much attention, partly due to the conservative nature of much of medicine (first, do no harm) and partly due to the absence of an underlying theoretical construct.  Germ theory of infection had not yet evolved and indeed would not evolve into broader acceptance until 1890 and later.  

Semmelweiss's experience is held as an example where prejudices established by tradition retard the progress of science.  Someone in 1850 knew what to do about puerperal fever but it was another half century before this knowledge was widely accepted.

But were they prejudices against women (many of which existed) or were they prejudices against change and risk.  In no account I have read of Semmelweiss's work have I ever seen the rejection of his recommendations attributed to the prejudice of male doctors against female patients.  It is always attributed to the incomplete mechanisms of knowledge sharing and the inadequacies of epistemic coherence.  

Berezow's claim of "long and inglorious past due to the fact that, for millennia, medicine has been dominated by men" comes across as mere political groveling and signaling in order to avoid stigma from feminists.  Maybe I am mis-recalling the history but it seems that Berezow is allowing the possible political consequences of his ideas to shape how he presents them.  The very thing he is accusing others of doing.

The difference is that his verbal cringe is defensive rather than offensive and is subject to debate and testing in a way that fashionable science is not.  

It is a good article but I think the enemy of good ideas is both under-assertion (not saying what is indicated as true) in combination with over-assertion (claiming something to be true that is not.)