Health

Skepticism in medicine, by Alejandro Vázquez Cárdenas

Skepticism, without going into details, is a Greek philosophical school whose greatest exponent was Pirron. Unlike denialism, the basis on which skepticism rests is doubt, therefore it is in total opposition to dogmatism.

Unless we live in a cave or on a desert island, we currently function in times of change, where information and doubt permeate everything. Some call it postmodernity, others globalization, others admit that the operation has overwhelmed them, but others simply close their eyes and do nothing. The reality is that we have all climbed, and / or suffered that change. To a greater or lesser degree, we doubt everything that does not fit our likes and dislikes, our way of seeing and understanding things.

Currently, in this 21st century, well-understood skepticism is more necessary than ever, especially in Medicine. There is a true tsunami of medical information labeled “true” and “scientific” that circulates and contaminates both social networks and an infinity of media with greater or lesser seriousness, from personal blogs to newspaper articles where verification shines through. its absence and it is common to find phrases such as “according to experts”, “scientists affirm”, “published in the prestigious magazine X” etc. They are news that, when properly analyzed, are only unsupported statements, incomplete reports, partial studies and investigations that try to be incorporated as truth in a tricky way. In general, all these sensational news end up being dismissed as false.

It seems that we forget that science is, in essence, open, critical and antidogmatic and that, due to its special characteristics, it always faces the principle of authority and upholds the need for verification and confirmation as generators of knowledge.

Skepticism has always been an obligatory attitude in medicine, and that is good, but for a long time the other side has been seen, which is to accept from the outset how much novelty appears in medical journals, which results in the doctor prescribing how much new product it appears whenever it is surrounded by an aura of “effectiveness”. Others follow an opposite path, we saw it in the recent pandemic, denialism, almost reaching magical thinking as a way of understanding reality by prescribing products that will only work in their imagination or outright embracing principles of pseudoscience and various “alternative medicines”. ” denying the effectiveness of modern medicine and considering the entire pharmaceutical industry as a mafia.

The good practice of medicine requires confronting statements whose sole basis is a principle of authority or tradition. We should only accept the evidence and assume as true the results obtained from measurable, repeatable and replicable observations.

Only that in medicine we face a big problem: The poor reproducibility of many things we do. This reproducibility is the Achilles heel of many disciplines that are considered scientific, and medicine borders on it, especially some specialties where it is impossible to accurately measure or verify what the patient reports.

In the search for precision we find the so-called biostatistical biases, where “p < 0.005" only indicates that we believe at 95% probability that the result obtained is not the product of chance, accepting the hypothesis as good. But not all is so easy. It was not until the doctor and researcher Robin Warren studying the relationship of Helicobacter Pylori with peptic ulcer that we discovered that all our knowledge and treatments about ulcers were based on false premises. By the way, that earned him the Nobel Prize in medicine.

And finally, do not forget how we quantify, we must know if what we are evaluating is being measured in an effective and real way. In daily life, a kilo or a meter is precisely that, a kilo or a meter, but in medicine, measuring “severe pain” is something different.

Conclusions

A healthy skepticism conditions us to be constantly updated, to doubt any approach that does not have solid foundations, to reject pseudotherapies and anyone who offers miraculous cures. In short, not to allow new treatments or therapies to be implemented in our activity without going through that sieve of doubt and its subsequent verification.

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