On Sat, 13 Jun 2009 02:17:20 -0700, Louis Schmier wrote: >I have to be in some agreement with Bob. To be aware of the >research or to utilize the results of the research, and to do the >research are two different things. And, it is presumptuous, maybe >even arrogant, to think that a person cannot "think properly," be >"wise," be up on her or his field, have no interest in what is >going on in their field, doesn't rely on someone else's research, >be an easy mark for extremist views, etc, etc, etc unless he or >she is in the "puttering around" in a lab or out in the field.
As long as we're making speculative statements that are not based on actual research results and using anecdotes as though they were data, I'd hazard a guess that clinicians and researchers *DO* think differently about phenomena. Their experience with specific phenomena condition how and what they think. I would suggest that non-researchers may be less concerned with the underlying causal relationships that describe the structure of a phenomenon (i.e., they are less concerned with why drug "A" reduces or eliminates a particular cancer, instead the mere fact that someone [presumably a researcher] has established that it does do some good and has become part of "best practices" is what is important). This focus may also affect what sources of information they use, say, clinically oriented journals instead of research oriented journals and how they read/interpret them (an aside: a friend from graduate school who has gone on to do child clinical work confessed to me that when he read a research article in his area he would just read the introduction and the discussion and assume that someone had verified that the method and results were "OK"). Again, I suggest to Louis that he spend some time looking at the systematic reviews on the Cochrane Collaboration website ( www.cochrane.org ) to get a better sense of the role of research especially in informing medicine and medical practice (where do think "best practices" come from?). It might also be useful to see how research informs social policy and social programs by examining the Campbell Collaboration (named after Donald Campbell and his work on program evaluation); see: www.campbellcollaboration.org . It is a sobering experience to see how little support there is for a number of medical procedures. Nonetheless, it is important for physicians to have an air of confidence in what they do and in making the patient believe that they know what they're doing when in fact they don't (e.g., what is the explanation for why antidepressants like selective serotonin reuptake inhibitor [SSRI} are effective in treating depression? What research evidence supports this explanation?). >I am here today, alive, cancer free, as well as being a surviving >walking miracle from my massive cerebral hemorrahage, because >of my physicians, who never did a stick of research, are intuitive >and insightful and critical in their diagnoses, dogged and hard-working >in their practices, sensitive to people, as well as being up on medical >things because of their voracious reading and constant retraining. And >trust me, they are anything but unwise, improperly thinking, and "easy >marks" for anyone. I guess Louis can be forgiven for thinking that a "testimonial" constitutes either evidence or "proof" that (a) he really knows what the causal mechanisms were that alleviated his conditions and (b) as a patient, he really knows the background, beliefs, clinical problem-solving and other components that his physicians used to treat him (of course, sheer dumb luck is an important component but physicians will rarely acknowledge this). He is a historian and is not concerned with establishing the types of causal relationships that experimental research is supposed to produce, especially in identifying why some clinical procedures will possibly produce good results, will produce bad results, or produce no real effects outside of the expectancies of the people involved in the treatment process. Presumably Louis is glad that his physicians kept up with the medical research literature even if they don't or haven't conducted research themselves but still had the skills of critical analysis to distinguish between research that is actually inconclusive and research that identifies treatments that will produce some benefit (what is really amazing is how much of the published clinical research fails to meet even basic experimental design considerations, thus making any statement about the causal mechanism that produces the benefit impossible). Earlier I provided a link to a website that provided an overview of "what proportion of healthcare is evidence based?" ( see: http://www.shef.ac.uk/scharr/ir/percent.html ) Louis has not referred to this but I wonder if he even understood what that different sources of evidence meant (i.e., RCT-based, Non-experimental evidence, and not supported). Louis has not mentioned whether he has gone to the Cochrane collaboration website to examine what systematic reviews are and how many of them show that the evidence for successful treatment of medical conditions is extremely variable (i.e., little or no empirical support to reasonably solid support). One of the lessons to be derived from the examination of these sources is that physicians are far less knowledgeable and capable of providing real benefits than they would acknowledge -- they, like researchers, deal with probabilities and the good physicians have some idea what are the probabilities of good and bad outcomes. Without high quality research to base these probabilities on, they don't have a clue about what will actually produce benefits (placebo effects and effects of other variables correlated with what they do may be more important). Louis, next time you go to your physician(s) for your conditions, ask them for the systematic reviews that are relevant to your treatment. If they give you a strange look and ask what a systematic review is, be afraid. Be very afraid. Finally, to the comments of Michael Smith: I see nothing in what you say that either represents reasonable general principles or empirical support for your claims (e.g., your statement about people going into grad school for psychology or to medical school really needs empirical support; there are several APA publications relevant to this point and I know that there are similar resources for medical students -- you really need to do your research on this instead of just making claims). I take what you've said as representing your personal opinion but I wonder what was it in your experience that caused you to take such a soured position. Frankly, I find some of your comments bizarre and wonder what kind of psychology you teach (e.g., how do you teach "the development of critical thinking in the individual Christian"?). I have a feeling that you definition of "critical thinking" may be different from that used by many psychologists. Just my opinion. -Mike Palij New York University [email protected] --- To make changes to your subscription contact: Bill Southerly ([email protected])
