Disagreements

Posted on October 4, 2008. Filed under: Everything you wanted to know about doctors, Personal philosophy, Self-deception |

Prologue:

Robin Hanson and I had a disagreement about the accuracy of an anecdote he used to illustrate doctor arrogance. I was dissatisfied with the lack of resolution to the disagreement, unless one considers “no change at all in either party’s postion” to be a “resolution”. He titled his piece “Doctors Kill“; it’s subject is nosocomial (hospital-acquired) infections. The anecdote:

A colleague of my wife was a nurse at a local hospital, and was assigned to see if doctors were washing their hands enough.  She identified and reported the worst offender, whose patients were suffering as a result.  That doctor had her fired; he still works there not washing his hands. Presumably other nurses assigned afterward learned their lesson.  

I objected that this anecdote was based on a third-party uncorroborated snippet amounting to gossip, and certainly in the category of ad hominem criticism. The statement “he still works there not washing his hands” is indicative of the inflammatory intent of the anecdote, since Hanson had no way to know what the doctor may have been doing subsequently. I pointed out that the anecdote added nothing to the statistical presentation of evidence, and as such was egregious expression (and strong evidence) of personal bias. I expected that Hanson, an extreme advocate for eliminating personal bias, would have seen that his personal bias against doctors had crept into his writing. Instead, Hanson replied that the nurse was also a a personal acquaintance of his, so the story must be true, and that his readers had found it to be valuable.

Analysis of Disagreement:

Recently I have come across Dr. Hanson’s post on “disagreement case studies“. Today, I will use his questions for analyzing our disagreement. It is a classic inside view-outside view confrontation. I have expertise in the way doctors, hospitals, infections, and hospital employees interact (outside view), and Hanson has knowledge and expertise for reducing the aggregate of medical activity to its economic and health value (inside view). The fact that his figures show that American medical care could be cut in half without adversely affecting (or perhaps improving) American health outcomes is accepted by both of us.

These are the questions Hanson suggests addressing about the participants in a disagreement:

  • Do you conclude just from the fact that they disagree that they must have more defects?
  • Do you think they realize that they can have defects, such as thinking errors or knowing less?
  • Should the fact that you disagree be a clue to them about their defects?   Is it a clue about yours? 
  • Do they adjust their estimates enough for the possibility of their defects?  If not, why not?
  • What clues suggest to you that they have more defects, or under-adjust for them?
  • What clues suggest to them that you have more defects, or under-adjust?
  • Do you both have access to these clues, and if so do you interpret them differently? 
  • Do you each realize some clues might be hidden?   
  • Does your inability to answer any of these questions suggest you have defects?
  • Consider all these questions again for your meta-disagreement about who has more defects.
  • My answers, regarding this specific disagreement:

    • Do you conclude just from the fact that they disagree that they must have more defects?

    No. Disagreement can be beneficial to both parties. It encourages the discipline of rational thought.  “Clearly our ancestors must have gained some evolutionary advantage from the tendencies that make us disagree; the challenge is to tease those out and decide which are still relevant today.” – Robin Hanson. I agree.

    • Do you think they realize that they can have defects, such as thinking errors or knowing less?

    Absolutely. Study of such is the avowed purpose of Hanson’s blog, Overcoming Bias, and many of his publications. I accept the sincerity of his effort.

    • Should the fact that you disagree be a clue to them about their defects?   Is it a clue about yours?

    Hanson has written: “A rational prior must be consistent with reasonable beliefs about the processes that produced everyone’s priors.” Consequently, our disagreement should indicate to him the possibility of his own defects, and questions about the processes that produced his priors on the issue. He should understand that disagreement from someone who has spent his entire career working in hospitals, dealing with doctors, nurses, and other hospital employees, accumulating a wealth of “outside” knowledge, is indicative that his position bears reconsideration. The fact that I disagreed so strongly, and that Hanson’s refusal to reconsider his position bothered me (and that I am writing about it even long after it occurred) suggests my own personal defects. Why should the opinion or the reaction of someone I don’t even know bother me? It’s not “doctor arrogance”, as Hanson surely would suggest; my other posts show that I am not in the camp of “I’m right because I’m a doctor”. Perhaps it’s evidence of “intellectual arrogance”. Perhaps it’s an expression of “intellectual insecurity”, in a confrontation with a person who has his own page in Wikipedia. I’m still working on identifying, and correcting, this defect.

    • Do they adjust their estimates enough for the possibility of their defects?  If not, why not?

    In general terms, I can’t say. In the case of this anecdote, clearly Hanson made no adjustment at all. I presented him with a large volume of “outside-view evidence” that would place the veracity of the story in a category of great doubt. Even if the anecdote were true, it added nothing to the analysis of nosocomial infections, save to further bias of the reader about doctors (doctors factually are far down the chain in the etiology of nosocomial infections, having far less personal contact with patients than that of hospital employees). He responded, but did not address any of the issues presented. While I may be a Bayesian in spirit, I don’t have the math skills to be one in fact. Were Hanson to presume me to be such, he has written: “Bayesians with different priors could easily disagree, though they would see no point in offering information to resolve it.” In that light, his lack of response would be explained, though still not addressing any possibility of defect. Far more likely, I think, is that he considers a doctor not worthy of his effort in a disagreement, because of his own priors.

    • What clues suggest to you that they have more defects, or under-adjust for them?

    Regarding the subject of this anecdote only, and not rationality in general: Hanson is precise, analytical, rational, and scientific when he discusses the aggregate effect of American doctors. He uses strong mathematical analysis to draw conclusions about the aggregate ineffectiveness of the health-care system. The clues that there is far more going on under the surface: use of inflammatory titles such as “Doctors Kill”; describing the aggregate activities of doctors as “fraud”, “scandal”, and “murderous malpractice”; use of an uncorroborated anecdote about an arrogant doctor causing the termination of a critic with whom he had no employer-employee relationship. He seems unable to separate the aggregate from the individual, when it comes to doctors. Given equal value of bits of evidence, he seems overly willing to accept evidence that presents doctors in a bad light, and overly unwilling to accept evidence in their favor. 

    • What clues suggest to them that you have more defects, or under-adjust?

    The major clue seems to be that I am indeed a doctor. The name alone (Hanson does not know me, beyond my writings of the Internet) conveys a negative connotation equal to or greater than the positive connotation that would emanate from a non-medical intellectual. Beyond that, I don’t know what clues he would have about me.

    • Do you both have access to these clues, and if so do you interpret them differently? 

    Yes, and yes. A clue about me perhaps not visible to Hanson is that I see my life in phases. I have completed my “doctor phase”. I am now again in a phase of “student”, yet to be determined whether it is a transitional phase, or an end in itself. 

    • Do you each realize some clues might be hidden?   

    I do, but I don’t know Hanson’s position on this. It seems logical that he does, given his long-term study of the subject.

    •  Does your inability to answer any of these questions suggest you have defects?

    Absolutely. That’s why I became an active student of Overcoming Bias.

    • Consider all these questions again for your meta-disagreement about who has more defects.

    I need help with this, since my concern is not so much who has more defects (this would be more of a concern if he were someone with whom I had a close relationship); my concern is more about the truth of the issue.

     

    These questions certainly cause one to reflect on the reasons for one’s position, in any disagreement. They would be much more valuable for analyzing a disagreement in which both sides addressed the other’s arguments. Otherwise, nothing is accomplished save a conclusion that is self-generated, and quite possibly inaccurate.

    UPDATE 10/5/08: Robin Hanson has commented: “you aren’t actually very clear what your claim is you think I disagree with.” If any reader perceives that the disagreement in this post is not clear, please state so in a comment, so that I may revise the post.

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    4 Responses to “Disagreements”

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    This is an awful lot of “ink” spilled to declare your “disagreement” when you aren’t actually very clear what your claim is you think I disagree with. I fully acknowledge that stories told by friends can be in error. Do you claim no one should repeat such a story? I really don’t know what you think we disagree about.

    Robin Hanson:

    mysteries exist in the map, not in the territory.

    Ask someone whose opinion you respect, and whom you consider to be a rational thinker, to read the post; see if it seems unclear to them. You have a habit, in your comments on Overcoming Bias, of saying comments are unclear to you, using that statement as a way to signal your low regard for the writer (or the comment). You are demonstrating what Michael Shermer describes as the reason extremely intelligent people find it so difficult to recognize their own biases or beliefs in weird things: their intelligence makes them much better at defending their biases, both to themselves and to other, perhaps less intelligent, people.

    This post is exactly what you requested in your original post: an examination of a disagreement, using your own questions. I would think you would be pleased that someone cared enough to do it, and give you free subject-matter for your book.

    Most of all, I am pleased to see that, after reading the post, you feel we have no disagreement. I assume that means we agree about the situation as I have stated it: the story was a cheap-shot, unworthy of the rest of your analysis, and almost certainly untrue.

    I passed on a story from a personal contact I trust. This doesn’t guarantee its accuracy, but suggested to me it was more likely true than not, and it was relevant to my post. You claim that my doing so was “cheap” (whatever that means) and that you know so much about hospitals that my story is “almost certainly untrue.” I don’t really know your reliability on such things to judge how much weight to give your claim. So I guess I’d like to hear from other people who have worked in hospitals on this.

    I claimed that it was a “cheap shot”, and you know exactly what that means (again using your technique of “I don’t understand what you’re saying” to signal low regard). As stated, “doctors factually are far down the chain in the etiology of nosocomial infections, having far less personal contact with patients than that of hospital employees.” Even if your bias convinces you that the story is true, it is not “relevant to (your) post” because it doesn’t accurately illustrate anything about nosocomial infections, and serves only to further your bias that doctors are arrogant individuals. You would like to hear from others because you are anxious to employ confirmation bias, instead of examining the bias that is already obvious. The next post further analyzes this and other biases in both of us.


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      The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.

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