Tuesday, May 29, 2012

I think too much on long weekends

Scientific Skepticism is a tool.  A wonderful tool to figure out reality, to learn what the facts as best can be known in a given situation.  However, it is a limited tool.  Over the extended holiday weekend I read Barbara Drescher's two thought provoking posts on her popular and well regarded ICBS Everywhere blog.  The first What "Matters" a commentary on the JREF's President's recent discussion that some skeptical topics matter more than others.  The second Mission Drift, Conflation, and Food For Thought discusses the overlap, but also clear differences between skepticism, secularism, and atheism.  If you have not read the posts in full, I suggest you do.  They are well worth the read.  My takeaway from the two posts is that skepticism is not a blunt instrument, but a precision tool. (All my terms, really read the posts.)  Unfortunately, many unwittingly (or not, I have not idea) wish to use this philosophic world view and perhaps its adherents to do other things beyond just learning how to ruthlessly obtain the facts.  Drescher contends this blurring of lines not could cause mischief to say the least.

I also listened with interest the exchange between Jay and Steve on the latest episode on the SGU during Jay's Swindler's List segment.  This time, Jay was upset that a major health insurance carrier would only reimburse its insureds for over the internet audiograms, rather the more traditional in office audiograms.  Jay thought it was clearly wrong for the carrier to substitute a less sensitive test method over the more expensive and more sensitive study.  Jay thought it was a swindle.  Steve, playing devil's advocate, pointed out that while the internet provided study was less sensitive there was a cost benefit analysis to be made.  In this case, the carrier was paying for some type of test rather than no test at all, or a more expensive test that would cost everyone (I assume the payers of the premiums) more since it was a more costly study.

In the Swindler's segment, everyone agreed the internet delivered test was not as good as the office test.  The question raised by Jay was a moral question.  Is it proper to save money by providing to an insured a lesser test?  This is not a question that can easily be settled with a ruthless skeptical evaluation.  Clearly, Jay believes the better test should prevail over costs.  My knee jerk reaction is to agree in this situation with Jay.*  You can run out scenarios of should every patient in the Emergency Department with chest pain obtain an EKG? Let's say yes.  Should they all get a chest x-ray?  I am not so sure.  Should they all get a full cardiac enzyme blood panel.  I guess not?  -Why the hell not?  After a bit, it starts getting rather pricey.  I suspect most readers would roll their eyes (including me) if someone wanted to pay for aura adjustment to calm the patient down.  

I could come up with climate change hypothetical responses, or energy policy question, but in the end after the facts are obtained as accurately as possible the what to do with them is often up for discussion without a clear right or wrong answer.  Returning to the medical question above, a libertarian might suggest the government more or less get out of the way and let the patient decide what to do based upon the market.  Others might suggest the government is duty bound for the best care possible for its citizens above all else.  Others might suggest freeing up competition between insurance carriers to help solve the issue of cost vs. care.  The facts are the same, the proposed solutions are different.  

A libertarian worldview will default to a more free market driven decision.  The conservative view would typically be market driven within a framework of checks and fair amount of government regulation.  The progressive will lean even more on government regulation, and/or direct government intervention.  Other world views such as a religious faith might have other solutions, but they all take the same facts and argue based on other ethical models what is correct.  

I know.  Nothing is 100%.  Homeopathy is crap.  I sure hate seeing governments at least tacitly condoning its use.  Vaccinations are a great boon to the health of society.  I loathe parents who chose not to vaccinate their offspring and dislike regulations that allow unvaccinated kids to mingle with other kids in school; it turns my stomach.  That is a moral choice that most agree upon in the skeptical movement.  Yet, I think it is wise to heed the limited usefulness.  Yes, none of this is an original thought, but sometimes a bit of reflection on the limits of scientific skepticism is useful.  Still, it sure is a powerful tool.

*Disclaimer: I have undergone both style of tests.  The two aren't even close.  One had me in an isolation chamber, and then in an entire isolation room and took quite a bit of time.  The internet version I took, which made me go oh-oh better get to an ENT doc was about five minutes to ten minutes in my living room with the tv off.    


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