“Can a
valid diagnosis be arrived at if laboratory tests are not available? Of course it can. Total reliance on on lab
tests to the exclusion of other factors when seeking validity is not science
but scientism” ~ Hannah Decker, Ph.D
In my post of April
1, 2010, Is “Data” the Plural of “Anecdote?” I pointed out that in most hard sciences, stories about a
scientist or practitioner’s personal experience can be contrasted with
“empirical” data from studies, and that the latter usually has more validity
that the former.
As I also pointed
out, however, “…many of the randomized,
placebo-controlled, double-blind drug studies can be every bit
as biased as the worst anecdotal evidence. We are now living in an age of 'marketing-based medicine,' as opposed to evidence–based medicine" (randomized = the use of chance alone to assign
the participants in an experiment or trial to different groups; placebo = inert sugar pill; double-blind = neither the person evaluating the
research subject nor the subject knows during the experiment if the subject
received the placebo or the active medication).
In psychiatry,
the situation is even more complex, since there are almost no objective lab
tests and we can't read minds, so we must rely on the experimenter's personal
observations, or answers by subjects to psychological tests in which we do not
know how honest subjects are being or even if they really understand the
questions, or patient self reports. All of these sources of data, while
important, are highly subjective and can hardly be considered "empirical"
in the same sense as, say, a chemical reaction.
Another big point
about anecdotes is that they are not worthless in science. Some of the most
important discoveries in all of medicine were based initially on anecdotal
evidence. In Part II of this post, I will describe how to determine the
validity and generalizability of conclusions generated from a group of “anecdotal”
clinical observations. That is, how can we tell if the anecdotes are the
typical situation seen with a particular combination of clinical variables and
which therefore can lead to a conclusion that will probably apply to most
patients with a given disorder? Are the conclusions probably true, or probably
false?
In this post,
however, I want to contrast conclusions based on a “clinical anecdote” with inductive reasoning. Remember,
the first step in the scientific method is observation.
According to
Wikipedia, inductive reasoning (as opposed to deductive reasoning) is reasoning in which the
premises seek to supply strong evidence for, but not absolute proof of, the
truth of the conclusion. It is usually based on seeing the same phenomena over
and over again without any exceptions.
The truth of an inductive argument is supposed to be probable, based upon the
evidence given. The same phenomena involving two variables are observed
repeatedly, and other variables which correlate with the phenomena are shown to
be not necessarily connected it, and a tentative
conclusion or assumption is drawn regarding the relationship between the two
variables.
Deductive reasoning, whose conclusions are more certain, is the process of reasoning from one or more general statements (premises) to reach a logically
certain conclusion. Deductive reasoning links premises with conclusions. If all premises are true, if the terms are clear, and if the rules of deductive logic are followed, then the conclusion
reached is necessarily true.
To anyone familiar with formal logic, deductive reasoning takes the form of
a syllogism:
All men are mortal
Socrates is a man
Therefore, Socrates in mortal
If the first two statements are true, then the third statement must be true. Deductive reasoning is
considered the entire basis of science by some
scientifically illiterate individuals.
The problem is that both premises in the above examples are inductive
conclusions! Just because all observed men have turned out to be mortal
does not in any way prove that the next man you come across cannot be immortal!
The first thing you should have learned from your Geometry 1 class in high
school is that there is absolutely no way to prove that the shortest distance
between two points on a flat two-dimensional surface is a straight line. It is
just that every time you measure it, it is. You just have to assume it.
I have a pen in my hand which I am holding about three feet off the ground.
Every time I have dropped it under controlled conditions, it fell to the
ground. I can never prove that the next time I let it go, it will fall. So
let’s see. Well, I’ll be darned. It did it again!
In other words, ALL scientific deductions are based on premises which are
unprovable inductive conclusions. Therefore, presto change-o, if no inductive
conclusions are scientific, then no deductive conclusions are either. Or in
other words, science would not really exist.
Syllogistically:
All scientific conclusions are based on inductive reasoning
Inductive
reasoning never proves anything
Therefore, no scientific
conclusions are proven.
Bullcrap.
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ReplyDeleteThis comment has been removed by the author.
ReplyDeleteExcellent points, Dr. Allen.
ReplyDeleteSince all psychiatric treatment is based on self-reports by the patient or observation of the particular case by the clinician, one might say it's all extremely subjective -- as compared to the objectivity ideally provided by a non-biased controlled experiment. (I said "ideally.")
A cluster of anecdotal reports can be the basis of a hypothesis, which then can be tested to come closer to objectivity. (I said "closer.")
This is exactly what infuriates me about psychiatry's dismissal of the large population of patients reporting injury from psychiatric drug treatment. Investigation could yield so much in knowledge, not to mention patient safety. It would enhance the reputation of the profession. And, you would think, it's the right thing to do.
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ReplyDeleteI'm a little confused by this post, usually I'm on your side 100% but it seems here that you're supporting the validity of so-called anecdotal evidence? Perhaps you're debunking the dichotomy between "hard" evidence and informal observation in the first place (originally I thought the starting quotation was meant to be ironic...)
ReplyDeleteI think the problem is not that the public demands too high a standard from psychiatry but that it accepts too low of one (to put it another way, it's not that people don't accept anecdotal evidence but they should, it's that what they *think* is "hard" evidence is actually "only" anecdotal...)