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Thursday, February 20, 2014

On faith and data

As a scientist with a brain naturally inclined to skepticism and analysis, I suppose my spiritualism may be best captured by: Keep the faith, but get the data. While some of my fellow skeptalytics, if I may coin such a term to catalog us, may be inclined to renounce that first clause altogether, thinking there is no need for faith, I am obliged to disagree.

We are all a mass of electrons spinning madly around their nuclear bonfires, with empty spaces inside every atom vaster in relative terms than those separating the planets and star of our solar system. That so implausible a thing as a caress is possible in such a world of empty spaces masquerading as solid surfaces where skin meets skin requires an embrace of the virtual realities perceptions devise, and thus faith in the prevailing illusion. Even the faithless have faith, if only in the reliability of the perceptions that get us through each day. To partake in the implausibility of this life is an act of faith.

With regard to an almighty, my personal faith is mostly in my own ignorance. The universe is so staggeringly vast and dizzyingly complex that to call it humbling would be like calling the Himalayas “tall” or the Pacific “big.” It is oppressive to contemplate how trivial we are in so colossal and intricate a construct. I can certainly understand the inclination to invoke designs other than our own to impart to us some importance we would otherwise clearly not possess.

But it helps me little in explaining the overwhelming complexities all around us to ascribe it all to an even more complex engineer of those complexities. If a Big Bang that seeded the universe is hard to contemplate, that much more so the perfect bundle that existed the instant prior, a fusion of every potential thing and thought, substance and sentiment to follow. We may shop the lexicon for labels as we choose, but something very much like “god” was implicated in that explosion, the source of all creation.

All I know for sure is how much I don’t know for sure. And that, really, is my topic here. This column is less about faith and more about missing data.

Religious faith, of course, is supposed to run in the absence of data. That, it seems, is the very test of faith worthy of the appellation. So the religiosity native to religion is understandable. Convictions born of faith in the absence of data are welcome, even encouraged, in houses of worship.

Still, the machinations of organized religion, the codification of faith into specific rules and regulations, scripted interpretations of the will of the almighty, might give pause to more than just we skeptalytics. The various notions of god that prevail in the world attribute to that entity mutually exclusive inclinations for everything from how best to get to heaven, to the right kind of headwear.

That the interpretations are mutually exclusive is self-evident. It is the very reason why there are different religions in the first place. And, of course, discordant knowledge of who, exactly, god is and what, exactly, god wants figures saliently among the goads to war throughout history, and to terrorism in the modern world. Admittedly, those same competing visions have inspired great art, great architecture, deep contemplation, and fervent compassion. But still, an incalculable sum of human suffering derives from our competing claims to absolute knowledge.

This is where I find myself troubled. We, of course, are rather trivial beings and all too fallible. So that we should bungle in any given context is a foregone conclusion. But across an array of competing attitudes and attributes, all major modern faiths do seem to agree that any god worth all the fuss is infallible.

How is it, then, that his/her/its radio is broken?

One must presume that a benevolent and parental kind of god, the very kind of god in which many of us invest our faith, wants the best for us. And since, as the saying goes, we are “all” god’s children, one might reasonably infer further that such a god wants the best for not just some, but all of us.

One might also allow, however, that free will does its mischief. Some of us are just disinclined to be good. Short of making us good by force, god, like any parent, must accept the liabilities of wayward children.

But what of the children who are not wayward, but rather misguided? If any given religion is right in all of its details (and if all of the details don’t matter, why, then, are there so many details? God either does, or doesn’t, care what kind of hats we wear), then every other religion is wrong. Since every faith is home to people who are good and fervent and ardent and kind—people eager to know the divine truth—it all begs a question. How can the correct divine signal fail to reach those eager to receive it? Worse, how can such people get the wrong signal and find it entirely convincing?

I don’t know the answer, but it shakes my faith. In science, we know darn well that we are missing data. Science is the struggle to know truths that are subtle, and at times stubbornly elusive. The only way to them is incremental, accelerated by the occasional epiphany courtesy of rare genius. Scientific truth comes together slowly, and along the way is riddled with fenestrations.

No surprise, then, that it is vulnerable to mischief and manipulation. Pieces of truth can be misinterpreted for, or misrepresented as, the whole. Sellers do this because it’s a chance to get on the gravy train. Pick the signal you prefer, cite the evidence selectively, and peddle, peddle, peddle.

No surprise then that we are sold mere grains of truth about science, and in particular, that area of science that matters most to me: The application of diet and lifestyle to health promotion and disease prevention. No surprise that we are sold mere grains of truth about grains and fats, fruits and nuts, feet and forks.

The surprise to me has always been that we buy them. Looking on as competing factions embrace divergent theories based on selective renderings of partial truths, I have long been surprised. I have wondered why people with good sense seemed to renounce its application when titillated with magical thinking about weight loss and health. I have lamented our tendency to accept at face value ludicrously exaggerated claims about single-ingredient scapegoats or saviors, and to infuse religious fervor into considerations of what and when make for the best breakfast. I have been forced to concede that perhaps desperation breeds gullibility.

But I have kept the faith that a larger, less partisan truth would ultimately prevail. I have clung to the conviction that truth is often immediately furtive, but relentless and ultimately indomitable. Seekers of truth are patient of necessity, obliged to be disciples of time. So far, I have kept the faith that eventually enough data would rally us to common understanding and common cause.

I do still hope so. But today I concede that in darker moments, my faith is shaken. Truths taken as divine are widely contested. If even an almighty signal fails to rise above the din of discord, how mad the presumption of hope for such lesser truths from we of such small voices. Maybe no signal can rise about the static in a universe where even god’s radio is broken.

I will cling to the faith that it isn’t so, but I sure would like to see the data.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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