THANK YOU for your support in 2022. This Christmas I'm donating my sponsorship fee to charity via GiveWell because I know it'll help those in need. If you can join me in giving something, please do - anything helps. Have a wonderful festive season! www.givewell.org/medlife
I'm not trying to be woker than necessary but why does a charity spend money on youtuber advertising? To me it doesn't inspire confidence they use their funds sensibly when they spend it on UA-cam ads...
When I was doing my biochemistry master's on the first day my work mentor asked me to guess how a particular biochemical mechanism works. I gave him one and he said that the explanation was very good, reasonable, and plausible. It was wrong tho because of factors I did not know or could have reasonably known. I learned then that no matter how smart you or your explanation are, reality does not really care.
I'd refuse reality and design a whole new biochemical pathway, with novel enzymes and mechanisms, proceed to build the genes related to their expression (and regulation nonetheless) and finally get a break together with a Nobel prize or two.
So true really I myself am constantly taught to create arguments that are reasonable and defendable even if flawed. I am not educated in the military sector but even with my limited knowledge, I can make a plausible argument that all the problems in my life can be attribued down to the military because I one day mentioned a technology they are currently secretly working on and they want to silence me. Why don't they just kill me? Because if they do then it will be suspicious if I-saying they are working on a secret technology-suddenly die! I can even bullshit my whole way to diagnosing a random person with adhd or autism even with my limited medical knowledge because I can create plausible arguements
@@gabrielsb3419 I'm more on the chemistry than the biology side, but biochem kicks my three letters six ways till sunday... Pretty much any time I think I've gotten a (loose) handle on wtf is going on another bombshell gets dropped on my head and I realise how little I know. There's like... two things I'm reasonably sure of? Fructose and seed oils are probably not great for humans to eat, but why exactly is this long, long, _long_ trip into biochemical pathways ;_;. And that's like a teeny tiny slice of the ridiculous insane world of just human metabolism ;_;.
There's a joke I heard a while back that I really like that came up in a discussion about cognitive biases and increasing awareness about them: "The only critical thinkers left are people who know they are not critical thinkers". Knowing about a cognitive bias in large part is knowing how blind we are to them when they are our own.
I was at Eli Lilly's launch of Xigris in my country. Champagne, fabulous food, and a popular singer giving a concert. Then about two weeks later I had a patient who I thought would benefit from this almost miraculous drug. She was in severe sepsis, and on 4 vasoactive drugs. Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately. She was weaned off the vasoactive drugs in less than a day and extubated 2 days after. The drug was a success. Afterwards we had no problem getting approval for its use. It was similarly useful in at least two more cases. We were believers, and when we saw that it wasn't universally effective, and caused some significant side effects, we were profoundly disillusioned. We bought into the hype, and were reassured by our own first experience with the drug. Lilly's explanation of the mechanism was completely bioplausible.
I looked this drug up and read its history. A number of years ago the rules changed about drug companies giving sponsored dinners\parties and whether CMEs could be given for these presentations. Basically CMEs are not given for most of these type of presentations.
The health care system privilege money shot: "Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately."
You started off your story with, "champagne, fabulous food, and a popular singer giving a concert. " Those are all red flags. Obviously they were trying to trick you..
"When you know a bit about metabolic pathways or NTs or cells it's actually easier to concoct things that confirm your beliefs" Every student of physiology felt this in their bones
your emphasis on human contact and concern being what is actually helpful in many pseudo-therapies is so accurate. we need each other as humans and when we feel lonely and depressed, that can manifest as physical symptoms. sometimes what we really need is touch and attention - someone to put their skin on our skin and listen to what's burdening us. the most helpful things my doctor has ever done to treat my chronic illness are to listen to my struggles, give me solid advice, and give me a hug. of course the medicine and lifestyle changes contribute to reducing the bad things but the social components of treatment help maximize the good things. we need each other and we can save each other.
Very true! I once had an interesting experience at the dentist: I had to get a root canal treatment and it was unpleasant and painful. At some point, the dentist put his hand on the side of my face to stabilize my head and it made everything better. This warm pressure made me feel safe and comfortable and that altered my perception of the pain. It was easier to endure. And we know that feeling cared for reduces the amount of stress hormones in your body and has other measurable physiological effects (on top of the psychological ones). Modern medicine needs to take this knowledge into account. "Holistic approach" is not just a buzzword. But of course all of that is being ruined by the profit motive of capitalism.
It is one thing to say that this kind of pseudoscience placebo effect may help in some instances, it is a completely different story to market these practices to the mass
Here's my take on the subject of human decency and caring: When you're looking for a family doctor, NEVER get a doctor older than 45. After that age, they've grown so used to death, and are so utterly numb to their patient's concerns that they are just counting the days until retirement. They've lost all passion for actually helping people, and are just going by muscle memory. The other day just to see if I was right, I asked my doctor for a random drug saying I heard it would help with weight loss. Without even looking up from his notepad, he said my pharmacist would have it shortly, and he didn't so much as ask me where I heard about it, or if I was experiencing any symptoms the drug was prescribed for.
What a wonderful overview. The mechanism fallacy is a great little label for it. My Christmas wish would be for my "independent researcher" parents to watch this and absorb its message, but perhaps as a direct result of growing up in a household filled with magical thinking, I no longer believe in miracles. But you were so even-handed and cool headed in your handling of the subject Rohin, I hope it does reach a few people who need to hear this message!
Thanks mate. Weirdly enough I was talking about you at a party today as a friend who is prone to flights of fancy has decided to write a book about typefaces 😂
Here's something that bothers me about the "independent researcher" archetype, though- it's often used by medical professionals to paint any patient who contests their way of doing things as similarly deluded by quackery. I'd been failed in my tendinopathies by GPs, surgeons & PTs who all pushed treatments not supported by science, before eventually solving the issue through simple load management and a single heavy load exercise. I'd been failed as a transgender individual by a specialized clinic that still operates on myths like that spironolactone lowers testosterone & woefully under-prescribes estrogen for proper androgen suppression despite minimally elevated risks with higher doses through non-oral RoAs. As a person with ADHD, I'd been failed by psychiatrists who prescribe the expensive 'Vyvanse', a simple rebrand of 'Dexedrine' that is functionally identical save for an attached-protein making it only able to be used via oral RoA, and makes me feel just as depressed when it wears off, as Takeda Pharma pushed that it was safer while conveniently collecting billions on a new patent. Similar was true of Adderall, a drug brought to market under a new patent through the inclusion of levoamphetamine- a chemical that had been indicated as *not* of therapeutic value decades prior due to its actions on norepinephrine making it bad for both the heart and anxiety. Meanwhile, mentioning the medication Desoxyn- known under a more popular name that might get this comment censored- has been met with shocked looks and abandoning me as a patient, despite how its lowered action on norepinephrine makes it more heart-healthy and its greater specificity for ADHD symptoms makes it have few side effects at the therapeutic dose. Stigma dating back to World War 2 dictated these doctors behavior more than the actual science of the chemical. And yet- whenever I've brought any of this up to providers- I'm seen as the deluded "independent researcher", despite how I sourced all of my information from a variety of journals & Science-based Medicine journalists, all in response to a medical system that was failing me.
@@made.online2149 Holy shit, are you me? Literally everything you just said is exactly part of my own experience dealing with the medical community, topic for topic.
@@MedlifeCrisis 07:40 Yes they are testable! a lot of work but they can be! Nobody will bother as we know theres no point it doesnt work! If they do dance with music near the plant it might make it grow better! :)
12 years into my self education of science in all it’s glory, and I was 100% unaware of my own mechanistic bias, in fact, i believed it to be a very promising indicator. Even though I was very much into evidence based medicine, I was stuck in a mentality of “it makes so much mechanistic sense, it’s clearly going to pan out in all the trials that are sure to come.” Thank you so much for helping me along in my journey, you may have saved my life or a loved one’s, because they or I will get very unwell eventually. Thank you sir
Science is ultimately a process of becoming less wrong, so all of our theories are always at all times limited and will miss certain things. They are a basis from which to start an investigation or to try to understand something but always come with the caution that usually reality is much more complex. Also it's all dependent on how well evidenced the theory is, there are some theories that are so rock solid that you can dismiss things solely based on them but there are others that are much more limited in scope and sure-ness (not sure what to call it but like how clearly you can predict an effect from a cause).
science shouldn't see itself (ego) as right or wrong but proven or unproven. to help seperate the ego of the dr from facts. i would be hard pressed to find a dr. who would say "vitamin D" is not doing anything. but as a primative mammel it makes me feel better to go outside everyday. but a dr. can't make person go outside. these are the problems we need to tackle
Omg, what a great video. I'm a med student and I could never make sense of why anyone ever said "stenting is effectively useless" when I knew it is a life-saving procedure for ACS. I didn't realize people used to just stent random people on the street just because they wanted to.
As someone in physics, I think the idea can be extended a bit further. The problem isn't just that people believe in things that are bioplausible (or just mechanistically plausible, in other fields). The problem is that we never truly have a perfect working model. If one actually has a perfect simulation or model of any system, then any mechanistic solution/therapy/fix that satisfies the model ought to work; however, we're never working in that perfect world, even in physics, and other fields just get harder and harder to model as we move away from physics. In other words, the problem isn't that we believe in mechanisms, but that we mistake out intuition for actual perfect models of reality. A nice label that's not field-specific might be 'intuition bias'. I see this all the time in physics, and honestly, the longer I've been in research, the more I find that I have to fight this bias, because one develops more and more intuition around models that are not exact reflections of reality.
I think this is also quite related to the current state of science, and how in the past, a single smart bloke could indeed revolutionize three different fields with mechanistic insights, because something like Newton's law of gravitation or Darwin's evolution, figured out mechanistically, makes sense and works perfectly for the understanding of the time. These days, models are so insanely advanced and the boundaries of science pushed so far that it requires entire lifetimes to meaningfully expand a single niche. There is no way to directly intuit this stuff anymore, best you can do is make some good hypotheses to be tested. But many get stuck in the old way, after all, it worked for centuries before, didn't it? Everyone is taught that you could become the next Genius of our Time, rather than the reality of contributing your study to many huge groups set up to probe topics far too vast for any one person to fully plot out from cause to effect.
This just reinforces my notion that the vast majority of science has probabilistic conclusions than absolute ones. Because we can't isolate, let alone IMAGINE, every variable contributing to the experimental outcome. But the effort can still be useful/important to build upon w/ more inquiry (go from a state of incredible messiness to something more organized). To attempt to make our models (and interpretations) more comprehensive, despite the impossibility of perfection.
A good example are the TNF inhibitor class of drugs, Humira, for example. TNF is an important cytokine that modulates immune responses. However, in some autoimmune inflammatory diseases, too much TNF is produced which leads to damage to healthy cells. TNF inhibitors were designed to bind TNF and thus prevent some autoimmune diseases. But it became clear in clinical trials that these drugs rarely cause or worsten heart failure. This is unexpected since, mechanistically, there is no reason to suppose that this should be the case. Still, it happens, and indicates an incomplete understanding of the role of TNF.
Totally different context, but it's actually a kind of bias that the arts struggle with constantly as well, especially visual arts. In order to recreate a believable model of reality you have to back engineer from all the automatic image correction and manipulation the brain performs, while still understanding that either you can know things that your eyes tell you are false (relative colour issues for example) or that would be devastating to your other functions in life to truly undermine and break. Thinking especially about where crafts intersect here, where over time experienced workers build up incredibly sophisticated internal models of physical understanding that may entirely bypass the concious thought parts of the brain, being encoded somehow as some sort of artificial instinct almost. It can be a very structural issue, at least to my knowledge, but my perspective from the arts actually gives me a lot of hope for compensating for this problem in science, once the awareness of the distortion is there, the opportunity to change it exists
While I watched this (commercial-free on Nebula, so thanks for that), I kept thinking of all of the folks I know who really need this information. As a retired scientist, my love of evidence is, well, evident. It drives my friends a bit crazy, but when they doubt the veracity of anything "sciency" or medical, they always ask for my assistance in researching the facts. I want to thank you for finding the time to make these humorous and educational videos. You truly are one of a kind and have a unique perspective. I wish you had time to produce more, but I do understand your time constraints. Have a lovely holiday and joyous New Year.
@@edcarson3113 All of them. I got the Moderna about 6 weeks after it was released and and have had 4 more, all without a single side-effect. Not even soreness at the injection site . I have not had covid, nor have I had a cold or flu since December 2010. Good hand hygiene and strong immune system 😀.
@@vivianloney None of my friends or family had side-effects, and only one co-worker did (out of dozens). So I don't consider "normal" to be lucky. Lucky is when most people have side-effects but you don't. Just sayin'... BTW, to avoid a sore arm, get injection in dominant arm, massage immediately after injection, then use arm as much as possible. Learned this about 15 years ago from a nurse giving me my annual flu shot. This year, I got both at the same time!
@@stephaniehyatt309 What a weird way to define the idea of luck- I don't think the concept of "good outcome of a situation of chance" has anything to do with normalcy. And side effects weren't abnormal. Something like 30% of people got side effects other than a sore injection arm after the vaccine.
As a philosophy major - I may not entirely agree with Popper, but it's incredibly refreshing to see some philosophy of science brought into this kind of convo, very useful and great job
I'm satisfied with the note that there are criticism and like 100 years of philosophy of science after Popper. A lot of philosophy inclined scientist often take Popper criteria as the end all of the demarcation problem
It's interesting how little the philosophy of science is taught in scientific degrees. I'm aware of Popper, but only through reading some Wikipedia articles after I finished my physics degree. You would have thought at least some discussion about what it was we were actually studying would have been worthwhile!
I'm curious what about Popper you object to? My main takeaway from Popper is the principle that you can't conclude something from an experiment that was not directly observed in the experiment. But this seems too high of a standard for most. Science stories that make the news are almost exclusively stories where the claimed results far exceed what was actually observed.
damn this was actually a really important video to make... as a junior-level chemistry undergrad student I certainly have a tendency to see myself as an "expert" among my friends and family who have no formal science background at all, and it wasnt until this video that i was really able to finally formulate the thought that maybe my ability to reason out potential mechanisms of cetain phenomena isnt actually as valuable as i thought? and in some cases may actually be way less valuable than my friends' and family's approach of just reading news articles about studies on things? i can't imagine that im the only person who's like this and who needed to see this video, so thank ronin
I think it's easy to fall into that trap and when you learn about science you'll keep falling into it and pull yourself out, not because you're arrogant but simply because you're hyped about suddenly understanding a new thing and being able to describe it precisely and make predictions. And of course you want to share that knowledge both because it's really cool but also because it might be able to help those around you. And it's really scary because you know that those around you will likely see you as an expert simply because you can recite things they haven't heard about and take your word for things. There probably isn't any surefire solution here, like you can't always stop yourself from getting excited so you just have to live with the fact that you will make mistakes and say things that are wrong, and try to always stick with the evidence.
Since it is tangentially related to a couple of things you mentioned, I thought I'd go off about a pet peeve of mine: RCTs in social science. While they are the gold standard in medicine for good reason, I feel like we have imported them without realising that some of the key assumptions aren't satisifed. Firstly, double blinding is basically impossible: you can't not inform people they've been enrolled in a school, for example. Secondly, the external validity is much more of an issue because of huge differences in social context. Thirdly, there are bigger issues with dropout and substitution because it's just harder to keep people in social trials than medical trials. I could use this to say something about givewell and effective altruism, since they rely so heavily on these RCTs, but I'd need to look into it more. (Full disclosure: I also use Givewell but I need to investigate it further.)
Another issue, of which you're very certainly aware, is how many social science research trial subjects are affluent, western university attendees, which is a very narrow subset of people who generally inhabit a shallow demographic pool...because universities are where research is being done (so I get it--I was a part of that machine). That leads to hugely imbalanced/skewed results that are not necessarily applicable to the outside/"real" world!
Rohin, thanks for another great discussion! Worth the wait. My new favorite saying: The road to Hell is paved with bioplausibility. EDIT: To say the ads that played during this video were ironic would an understatement.
I was once by a patient's hospital bed when the doctor came by. We asked if a certain treatment could be tried, which would have made the patient more comfortable. The doctor gave an answer, which I thought weak at the time, but I now realise showed high training and courage: "there's no evidence that it works."
Depends on the treatment, if there's llittle cost and risk, there's no reason to deny it. Not to mention, for new treatments to be found they have to be tried first, and if there's no interest in a treatment there'll be no funding for studies either.
I second Stee; it's not about whether there's evidence that it works. The question is whether the potential benefits outweigh the potential cost. No risk interventions should be tried willy-nilly, especially if the patient wants to try it. The only caveat is that the risks include opportunity costs, so make sure you're not forgoing treatments that do actually have evidence behind them.
I really appreciate your discussion of ICU patients. My mother was admitted thru ER to the hospital after being told her high blood sugar (diabetic for perhaps 20 years) was alarming on a cardiologist's blood panel. That night before going, she also had an issue of clear fluid weeping from her legs, fluid retention from congestive heart failure. The next morning we visited her in her ordinary hospital room where she complained about the taste of a potassium supplement she ended up not being able to finish. Later that night, she had a cardiac event and was found in the bathroom un responsive. She was taken to ICU and spent almost three weeks there while the doctors monitored and assessed every detail. By the end, after she had aspirated and was too tired from being constrained from bed, she made the decision for a DNR and halted treatment. An irony, her legs had fully healed in that time, so if one's observations were blinded to the liquid food and other sources of pneumonia that ultimately ended her life in hospice, her fluid retention and leg wounds had been completely addressed. Thank you for your work, and sharing your voice here on YT. As a math student in college, I have huge appreciation for science, and often tell my nurses "I can tolerate anything for science" such as blood tests, nasal swabs, and throat scrapings. That month of being in hospital with my mother, I was angry and disappointed that science didn't have a perfect solution for her, but I still appreciate that having a way of telling that we're capable of wrong is the best part of science. Ultimately, the human connection that her doctors had with us helped us come to decisions, and while I subscribe to a Diet-Zen "life is suffering" and agnostic approach to the afterlife which I don't think I could make the same decision my mother did, I am gracious to compassionate medical staff willing to talk to us and answer our questions.
Thank you, Rohin, for your time and work invested in this type of content. As a med student, I can still remember, when learning the basic sciences (physio, biochem), I thought that I knew so much and would eagerly await the time, when I become a physician and would be able to explain my patients their diseases and treat them based on my mechanistic understanding. Now when finishing my studies I am much more aware of the limitations of investigating such complex subjects as humans in health and disease with all kinds of variables possibly playing a role. Now my wish is not to be mechanistic know-it-all, but to be a prolific "reader" of research. In words of Siddhartha Mukherjee: "But most doctors don’t really hunt diseases these days. The greatest clinicians I know seem to have a sixth sense for biases. They understand, almost instinctively, when prior bits of scattered knowledge apply to their patients - but, more important, when they don’t apply to their patients. They understand the importance of data and trials and randomized studies, but are thoughtful enough to resist their seductions. What doctors really hunt is bias."
In charity too, interventions with plausible sounding mechanisms often turn out to have basically no effect. The economist Michael Kremer found that additional textbooks, flip charts and even teachers donated to poorer schools in Kenya had basically no effect on test scores when put through an RCT. However, de-worming drugs (to cure intestinal worms) had an enormous effect. GiveWell tries to find interventions backed by solid evidence rather than just plausible sounding mechanisms. For more on effective charities etc., I recommend the book "Doing Good Better".
Charity usually takes place from the perspective of the giver, not of the recipient. The idea of children being too sick with worm diseases to absorb education seems too disgusting for Western people.
An extreme example I like to make is that "Smoking is healthy, because it helps manage stress" - sure, many people certainly feel eased when they can finally smoke after a stressful situation. But that doesn't induce that we should smoke or even that smokers are less stressful (I'm similarly skeptical about the alleged benefits of modest alcohol intake) Great video, enjoyed a lot!
Ah, but tobacco has been tested in RCTs. It does work, and if you're dying anyway, it might be worth the damage it'll do. (Don't mind me, that's my depression talking.) But in all seriousness, it's worth testing. Consider chemotherapy, which by all means is terrible for you. Or even surgery, the application of wounding a patient and exposing them to dangerous pathogens to help them feel better. As much as I try to keep primum non nocere (yeah, that's probably spelled wrong) close to my heart, it cannot be the only guiding principle.
Hmm, ah I missed that. I need to find another example then. Thanks for pointing out. (My other point with smoking is that there are various other ways to reduce stress, and maybe tobacco can also be consumed in other ways that aren't that harmful. But still, if it indeed shows effect in RCTs then the key point with my example is invalid)
To my understanding, a lot, if not all, of the benefits of alcohol disappear when you correct for income (especially the supposed benefits of wine-it turns out the people who can afford to drink it regularly can afford better health care in general) and that a sizable portion of non-drinkers are abstaining because they previously abused alcohol.
@@er00ic Or abstain because of pre-existing physical or mental health issues. Yup. This was my immediate thought on hearing about that result. It doesn't mean it is correct though of course, for exactly the topic of the video. I guess I have another mantra to add to my logical toolset: A plausible mechanism can only ever expand the solution space, never shrink it.
@@marenjones6665 if smoking is helpful because it reduces stress, you'd need to prove it reduced stress better than the gazillion things that reduce stress without causing lung cancer or other types of cancer Also, afaik, if a stimulant is reducing your stress, either you have ADHD or the stimulant isn't reducing the stress at all, it's just reducing your craving and getting you back to the baseline you were at before you took up smoking
Thank you Rohin for once again providing content that bucks the algorithm by being both rigorous *and* entertaining. You're providing a service to society well beyond giving us all something to fill our evenings (but also that too!).
This is absolutely first class work. I have to say this is one of best pieces of content I've ever consumed on this platform. Thank you for the thorough work to produce this
So I watched this when it first came out. I just re-watched this and this time it really hit home. I think I am ready to "hear" this now because I just got so tired of chasing my mechanistic wellness tail. I just want to live as well as possible yet realize that eat well, sleep well, get a bit of exercise are the "real" secrets. The only thing I would add to that would be to have at least one good interpersonal relationships, because we are social creatures.
You apologised for the first mention of epistemology, as if it might prompt people to leave the video, but that was the scentence that made me think "oh I'm definately watching all of this".
From my background, it's interesting to note that the mechanistic bias also shows up in realms that you'd consider very pure and logical! In software, if you want to optimize the speed of your code, it's really vital to have good measurement tools. If you just follow rules of thumb about what "should" make things faster, you might "solve" something that wasn't the bottleneck in the first place, or even make things worse. Especially when you get down on the really low level of machine instructions, it gets really really hard to predict what's going to ACTUALLY be faster without just trying multiple approaches and measuring what works best in practice. You'll have people insist things like "but my code aligns data on cache lines!" as if the performance gods are obligated to reward your rain dances, when a hundred other little factors like inter-core contention might make your code slower. Ultimately, there's no proof except proof, and you have to be kinda stubborn about it. Rules and models can be very alluring sirens for the unwary.
The law of "Unintended Consequences" comes to mind with code along with "Well, it worked on my machine". :) It was bad enough back in the days of "single function computers" running one program at a time. Today it's hard to guarantee that Microsoft won't release an "upgrade" (and your IT department roll out) that breaks/degrades you code without warning. I got hit by a couple of those.
And I mean we do actually know for certain how computers work because we built them, so this isn't even like medicine where a lot of the time there's something we didn't know that messes things up. It just goes to show how quickly a system can evolve to become so complex that we have trouble truly understanding it.
@@hedgehog3180knowing how each part works and knowing exactly how the will behave when put together and then used in a very specific way are two very different tho.let alone how a piece of hardware should work and how exactly it will work aren't always the same, especially as manufacturing isn't completely perfect.
See and this dovetails into everything else: -I really like you know, "healthier" foods, but access to them isn't amazing where I live(I tend to subsist on frozen broccoli and green beans a lot) -I can't walk safely in my neighborhood, there's no sidewalks and people go down roads at 65mph -I try to sleep enough and prioritize my sleep, but I've had jobs call me in or schedule me for awful shifts over and over, messing up my sleep schedule. I think within this is the part where we created an environment where none of these things a prioritized, and then we're having like, solutions sold back to us in marketing schemes because like you said "Eat a healthy variety of foods, Go Outside, and Get Enough Sleep" isn't much of a marketing plan. Drew Gooden even came to this conclusion with his video on his Sports Guy Diet--that the food was good and helped him feel better, it's just not easy to market "you'll feel less like crap all the time".
An hour of Medlife Crisis before Christmas? Best Christmas gift I've received today! No but seriously, thank you for all your videos both this year and before, you're honestly one of my absolute favourite channels and I always learn something new and get another view on your topics. You make me think from different perspectives and are a great teacher, and funny, entertaining and interesting to listen to!
You've made at least one biochemistry PhD rethink his biases, and for that I thank you deeply! Only criticism is I would consider having longer breaks between the sections as it is quite a lot to take in 😅
Having watched you for years now you have earned my complete trust. Other UA-cam videos I watch skeptically realizing that most of them are just commercials for something. But with you I take everything you say at face value and never give it a second thought. Thanks!
Top notch. So valuable to get a contemporaneous medical perspective from an experienced, ethical medical practitioner; this also pairs nicely with the TedTalk. I remember listening to Huberman and Sinclair and thinking, "These guys are making huge leaps of logic", but doubting myself since they are both associated with some very respected educational institutions. I do like the NIH lectures and UCSF Mini Medical lectures. I will take a look at your recommendations as well. Happy New Year! I see your assistant has had some craniosacral therapy.
Terrific video as always Rohin! I seldom comment, but as a student of social sciences I actually had some thoughts about both the demarcation problem, and the marketing-lingo of modern pseudoscience. So I thought I would put my two cents in. First, while I think it is very good that you put in the distinction between clear vs. messy sciences in the sidenote to delineate between sciences that benefit from mechanistic modeling versus other sciences, I think it is also important to reflect on what we mean by "science". Because the demarcation between science and non-science is often (as you mentioned) murky and unclear, but it is also littered with questions of institutional politics, _scientific_ methodology, and ideology to maintain a sense of objectivity that defines science for both scientists and the public. This is not to say that science is doomed of course, only that every time we speak of science and its pseudoscientific counterpart we reenforce certain narratives about science and scientific objectivity (the jargon term for interested parties is boundary-work). This is actually vital to the creation of new science and scientific fields. Second, I think that the argument made towards the conclusion of your video about sexiness of sciencey-explanations could be understood as a part of larger cultural trends. Specifically that the sexiness is precisely the problem we are seeing in large aspects of society. From social media spectacles that turn out to be marketing ploys, to images of bodies that are heavily edited, to these bio-plausible but pseudoscientific arguments. Instead of wading into the often complicated endeavors to accumulate new knowledge, we get a simulacrum of a scientific argument. A watered down, but effective marketing argument for a certain treatment or diet. It would make sense that the larger societal shift in mass-media, economics, and politics would also trickle through to areas in academia and medicine. The problem you are describing in medicine or science in general is also a cultural and political one, I think. But those are just some inputs from my social science perspective which could make some sense to stuff like this.
I've just set up a monthly donation to Give Well. Thank you for your suggestion. And thank you for your informative, entertaining videos. My favourites are still the ones with your darling baby boys.
This was great, really opened my eyes to the mistakes I was making. I have major depressive disorder, and I and my providers have hit that point where we're throwing stuff around to see what sticks. Since brain science is equal parts poorly developed and deeply complicated, it's been a ride. Recently went down the folate wormhole and did not come out unscathed. I think I'll go back to looking at treatments that improved mood in RTC with no clue as to why. Also still working the basics.
He's practically saying nothing works and if it works for you - you must be a biased fool. So I don't see what you heard (into) this absolutely ridiculous rant.
In my own travels on that patjway, I found that a classically balanced diet was having a profoundly negative effect on not only mood, but the effects of medications. Abandoning that and just making sure I get a reasonable amount of various nutrient groups in rotation over the course of a month or so, restored function to my medications and some sanity to my life. Go figure. Not everything works for everyone, but I do know that going overboard for any one thing is generally a poor idea. Good luck; suggest going back to basics, and work with what successes you can find to light your way.
For a succinct description of our cognitive biases, I recommend the book "You Are Not So Smart" by David McRaney. There's also the classics by Ben Goldacre: "Bad Pharma", "Bad Science", and "I Think You'll Find It's A Bit More Complicated Than That".
Ben Goldacre is an entertaining read, up till the point when you realise that the bad science he is exposing has killed people. Then you realise it is serious. Ought to be required reading.
@@andrewharrison8436 Ah, don't be such a downer. Hasn't killed you or me yet, nor is there a shortage of people ;) Just my joke there... My point is that it's a good thing that Goldacre presents the absurdities in a half-joking way. It's hard to get people interested in serious stuff, their lifes are usually full of that sort of thing already. If you want to raise awareness for a problem, providing a bit of entertainment while you do is a good thing. It helps the cause by bringing entities on board whose only interest in the problem is to make some money out of it (meaning publishers and the like).
@@andrewharrison8436 Phil Plait's 'Bad Astronomy' is along a similar vein. It killed people too, albeit usually for the science being perceived as heresy against the Catholic church!
Thanks so much for this long video. I know there's dinner virtue to editing down to Tom Scott sized single topic videos, but I'm very happy to listen to you talk for an hour
I forget who it was attributed to, but there's a quote that summarizes this mechanistic bias nicely: "In theory, there's no difference between theory and practice. In practice, there is."
This is an amazing video. This should be taught in 1st year in all universities so that students get an idea of how susceptible our brain is to such fallacies. Thank you for making this, I've been watching you for sometime, but with this one you earned my subscription. Very well thought through and presented. I'll be using some of your arguments next time a relative/friend comes up with these kinds of ideas again.
I assure you there are plenty of schools teaching this stuff, and the students are snoozing through class and then going back to the dorm and whining about how much they hate that stupid stats/methodology course. You can lead a horse to water...
I have ectopic beats and they can be really horrible. It’s scary to think that if I was diagnosed 10 years earlier, I could have been put on a medication that was possibly life threatening.
Just for clarification, it was in patients who’d had heart attacks. But your point remains, people had strange ideas about ectopic beats even quite recently.
Givewell seems like the organisation I have been hunting for for years- thanks so much for introducing me to it. Great video, really good for grounding the ever so excitable mind back to EBM. Also now you've nicely condensed into words why I dislike medical influencers so I can feel smug when they appear on my screen- thanks Rohin!
Just happened upon this channel: This video is great! I like his style 100% and his approach to science also a lot: Mechanistic explanation DOESN'T equal actual effectiveness. An mechanistic explanation is just that: a POSSIBILITY. Not 'true' untill proven right, as in an actual convincing trial. Thanks dude. You got a new subscriber.
Really happy to see you mention Popper when you talk about epistemology. For an even more modern take which further develops Popper's, I highly recommend "The Beginning of Infinity" by David Deutsch; it's a remarkably rational and insightful presentation of how and why progress in knowledge is possible. He also has a paper, "The Logic of Experimental Tests, Particularly of Everettian Quantum Theory" which is freely available from a link on his webpage. You can skip over the quantum mechanics stuff and just read the bit about experimental testing. In my opinion, David has the most brilliant theory of the philosophy of science to date, compared to a lot of other stuff you might find (Bayesianism etc.)
A lot of people seems to think science is about "right" and "wrong" - so that one party can go say "hah! I was right - told you so! (and by that I also imply you are an idiot)". The whole idea is prediction. We do not need to "prove the earth is a sphere" so flat earthers can be mocked. But using a globe model of the earth lets us make useful predictions - that helps us in anything from metrology to navigation.
@@jarls5890 That science is only about prediction is actually one of the misconceptions David corrects in his book. In short, what science is about is seeking "good" explanations; an explanation that is hard to vary (changing the elements of the explanation) while still accounting for the phenomenon it purports to explain. What is and isn't a "good" explanation also depends on the totality of our knowledge at any point in time. The "flat earth" theory is a "bad" explanation because it conflicts with many other things we know of. For example, we know from physics that the gravitational force is spherically symmetric, which would pull stuff into a ball, not a flat disk. David also talks about how science is problem driven and conjectural; it always starts with a conflict of ideas, something you didn't expect or expected to be otherwise, and solutions to these problems are guesses, bold hypotheses which can be criticized and altered until a tentative solution is reached. He also has a TED talk on youtube that is worth watching.
@@Daniel-vu7pi I see no conflict here. Deutsch's "A bad explanation is easy to vary" is perfect for scientists and those who "believe" science. The problem with it is when talking to the less scientifically inclined - or the ones who straight up distrust science - and especially distrusts scientists (and very much so if a scientist gets to define "good" and "bad").
I can't believe my layman attempts to understand (what I now know can be conceived as) the Everettian interpretation and experiments, testability and our subjective experience work in that framework without stumbling into anthropocentric Deepak Chopra territory has been spurred yet again by a UA-cam comment.
dear Rohin, (or Dr. Francis?) it is so nice to hear you speak i such a kind and non-cynical way. don't get me wrong, i appreciate the sharp ultra-intelligent, hard-crust sarcastic innuendos. as an art. and it feels good to be part of a club of the chosen ones who can catch them quickly and also serve them with a straight face to those who have no idea... but it is SO heartwarming to see you well rested and kind and patient actually explaining stuff with compassion. no elites. very unifying and human. i have just rewatched this video after seeing some of your recent ones and the contrast is so big. this is no critique. we just appreciate you and all bright lovely minds and hearts of this world. i guess what i meant to say i hope you are well and have enough time to rest and enjoy life and your loved ones. many many thanks from austria.. (mother of 3, non-native here, also english is not my fist language. so in case i made no sense: we love and appreciate you. hope you are well, fed and [reasonably] happy 😉) 😉❤️🙏🙏🙏 thank you for what you do. you have no idea what it means to so many you will never meet. just helping me keep my sanity during the dark times of covid, masked kids and homeschooling while on zoom business meetings (maybe just escapism, dunno and don't care 😂) made SUCH a difference. and generally: whoever appears on the interwebs speaking kindly, basing assumptions on some facts and keeping the big picture.. just. thank you. humanity has a chance.
From Australia the "black swan" example seems really silly. For us it's white swans that are rare... which probably shows something about selection bias or cultural relativity or something.
I’ve got the same thing with the “when you hear hoofbeats think horses not zebras. I’m South African, I’m about equally as likely to see a zebra as I am to see a horse 😅
I love your videos, informative . However when you post quotes maybe keep them up on screen for a few seconds longer, depending on word length. I read fast but sometimes can’t read the last few words.
Modern conventional medicine in the UK normally does the exact of opposite of giving you a nice human interaction, you normally just rudely get told to go away...
Thank you so much for this. I've got sucked into the Andrew Huberman podcast vortex and started to seriously consider some life changes based on his claims. Visual flow, sunlight in the morning, etc. While none of these would be harmful, it just changed my way of thinking about these claims. An that's why we need you, to shed light and slap us back to reality every once in a while
I don't know why exactly Huberman recommends it but getting some sunlight on your face in the morning is almost certainly good for you. Definitely a mood booster. We're hardwired to respond to sunlight. Our circadian rhythm is powerful, man!
@@Christopher-md7tf lol, some people I've been in touch with couldn't comprehend the benefits no matter the format or medium. I wish it would be easier...
Playing devil's advocate here, but what you're basically saying is: "this guy says X and I believed him. Now this other guy says X is wrong, and I believe him instead"? I'm assuming you're a layperson, just like myself, and have no way of verifying either the research cited by Huberman, nor Francis' claims that this research is flawed. So how are people like us supposed to make up our minds? That's the real problem here. Aside from the fact that different experts will interpret the same data differently, which doesn't make it less confusing, folks like us simply don't have the required knowledge to "do our own research". Nor the time, for that matter. We need experts to summarise the research. And what Huberman contributes in this space that makes his podcast valuable in my opinion, is that he doesn't just point out statistically significant correlations, but distills actionable protocols that are easy to understand. E.g. he doesn't just say "exercise more", he tells you which type of exercise is beneficial for achieving whatever goals you've set, and how much is sufficient to reap the bulk of the benefits before you hit the law of diminishing returns.
@@EvenTheDogAgrees I don't usually reply to comments or contribute to threads as I believe online commenting and arguing is counter-productive, harmful even. But you made some good points and touched on a topic I find really interesting, especially with the recent developments in Large Language Models. Indeed I am a layperson. I agree so much with your statement here and the sentence preceding it: "Folks like us simply don't have the required knowledge to "do our own research" " But I would even go further, relying on this quote: "There are no facts, only interpretations." Even if we can interpret the data, that's what it is. It's interpreting it in our own way, instead of digesting the interpretation via Medlife Crisis or Andrew Huberman. I've seen vastly different interpretations of similar or the same studies with varying conclusion. Also, I'm not disputing that Huberman contributes to the space by condensing research into digestible pieces. To address your first statement: "this guy says X and I believed him. Now this other guy says X is wrong, and I believe him instead" In this scenario it's just simply about echo chambers. This channel and the information provided was a valuable voice of reason, a counterbalance to some of the claims made bu Huberman. If I would seriously consider whom to believe, I would look behind the scenes. Huberman, while receiving income from his academic contributions also benefits hugely by the increased social reach. (content monetized) He hired a team to pre-digest these studies and now, instead of focusing on his field (which I totally believe he is an expert in) covers a wide array of topics. He follows the Joe Rogan, Lex Friedman, etc. podcast bro wave. It's his job and main source of income now. He benefits from more content, more reach and engagement, etc. So if I'm choosing which "truth" to believe, I'm going with the one that doesn't benefit for more people watching or sharing it. (or at least only partly) Please don't take it as a personal attack on his character or his work. This is just what I would consider. I think he indeed adds a great value, but can also get carried over and provide quick decisive conclusions. All I'm saying by my original comment: It's always nice to hear another perspective, because, at the end, we are easily deceived, even when it's based on scientific research. (which used to be my single root of truth, but turns out studies and interpretations are both flawed - and not created equal.)
When the nurse at the psychiatric hospital I was at was recommending vitamin-D for my depression, I just wanted to scream. What was worse was after when she ordered bloodtests for my serum vitamin-D level, apart from regular tests; and my results came with high levels of Vit-D, she buried her head in the sand and told me I should take more of it.
To be fair, giving people big pills that do nothing is probably one of the more effective treatments for depression, but only if the patient thinks it helps. I hope you found something that works for you!
@@armadillito Well in terms of medication yes. In terms of treatment 30 minutes physical exercise iirc dwarfs everything else we've tried for most people.
My cat lost a bunch of his teeth due to "tooth resorpotion"...nobody knows what causes it, but one of the leading theories is too much vitimin D in commercial cat food. (There is no upper limit for vitimin D in pet foods.) (Edit: Getting a friendly cat (or dog) is almost certainly a better treatment than vitamins!)
Some people are known to give placebo because they think it would help. Just like some people pray all the time, as if any of those wishes will be answered. If you believe the Vit-D nonsense, the placebo effect might work on you. Even if it does not, taking extra Vit-D does not pose any harm. That is the rationale for some docs. It may not necessarily come from pure incompetence.
@@frankxu4795 a nurse is not a doctor with diagnostic training. And if a blood test comes back reporting high vitamin D levels yet said nurse still recommends taking more vitamin D, that's incompetence.
Thank you for acknowledging the merits of non-scientific practices. Understanding the limitations of science is fundamental to its application, and accepting the value of untestable beliefs is key to stripping those beliefs of scientific costumes. When an experience can be accepted for its subjective benefits, there’s not need to dress it up with supposed scientific credibility, especially when applied in areas where science is known to be unreliable.
Here from Nebula (they really need a comments section). Vitamin D is a huge deal to my dad who works as a locum GP and those he works/used to work with, he's constantly going on about it. My GP is where my dad used to work (now that he left I can go to the nicer surgery), and so basically all of my requests go via my dad to my GP and it's handled immediately. I needed some bloods taken and needed my GP to sign off on it, he screenshotted their texts to tell me it was done and that I now just needed to book the appointment, but in those text my GP mentioned that the labs are currently declining doing all vitamin D testing (I guess it really is that pointless), and she went on to say that I should just take vitamin D suppliments (I already take multi-vitamins because why not it's cheap and some of the vitamins are essential), they then both spoke about how important it is and how vitamin D deficient everyone is in the UK. My dad is still holding onto low vitamin D = higher risk of bad covid. He's aware of correlation does not equal causation, he used "quack" the last time we spoke, he's constantly shitting on the latest health thing my mum finds on instagram, and yet still holds onto it as fact. In every other regard he can show that he's not an idiot, he's an incredibly well loved and caring doctor (at school, I was relatively popular because a lot of people had my dad as their GP and they love him), he never does anything wrong, but he can focus on the wrong things that have no difference.
For me, something doesn't add up about this whole vitamin D debunk. If vitamin D supplementation doesn't provide health benefits, it must mean one of two things. One reason could be that there's no such thing as vitamin D deficit, because no matter how low your vitamin D level is, your health outcome is the same. Could that be true? Then why do recommended/normal levels exist? How were they determined? The second reason would be that vitamin D supplements don't really affect the level of vitamin D in your body. How could that be possible? Either the digestive system is not able to ingest vitamin D from food (we would know that by now, right?), or all the supplements are fake. Could there be any other explanation for supplementation not working? Another thing, it seems there's more to vitamin D than "bioplausibility". I'm thinking of the fact that people's color of skin is directly correlated to the geographical latitude of the place their ancestors lived in. Some people even have a special mechanism that makes their skin color change depending on the season. We don't see such correlations and mechanisms in other species close to us. This suggest that it's really important for human body to receive just the right level of sun light - it's significant for our survival. I thought that vitamin D was the explanation for this. If not, we have one more mystery that needs explanation.
Hi fellow Nebula-follower! I agree, the thing I miss most on nebula is being able to greet and thank the producer. Downsides of a comment sections are, of course, moderation requirements. An unfortunate truth of the internet since the 1990s.
@@speedstone4 Hi, I didn't know about some people having a special mechanism that makes their skin colour change depending on the season, I'd like to know more. I'm presume you're not just referring to people getting a tan? Is there a specific source you can recommend? You raise some interesting points about the biological pathways. One thing I've heard is that Vitamin D3 is more bioavailable than D2, as it is the natural form the body makes - but it doesn't necessarily travel the same route of course. One of the things that led to vitamin D as being suspected as being a factor was that in the UK people with darker skins tended to have worse outcomes from Covid, and who also tend to have lower vitamin D levels, but I knew people with relatives in villages in India and Africa where they were wondering what all the fuss was about and large funerals and weddings were carrying on as normal with no apparent consequences. Also in Israel, they discovered that orthodox Jews with the clothing covering more of them and wide-brimmed hats that keep the sun off their face were also much more susceptible to covid. Of course, we nearly all spend more time out of the sun in the last 100 years than in the previous tens of thousands of years, so the actual sun may very well be a factor.
@@herseem Of course I was referring to tanning. I just wanted to point out that it's not "just" tanning when you think about it, it's quite an impressive development that evolution has come up with, so there must be an important reason for it. So your suggestion is that the actual sun light is important, but it doesn't explain anything. It's not like white cells need to be directly hit with a sun ray before they start functioning properly, right? There must be some mechanism. If we can figure it out and come up with interventions that can be used when sunlight is not available, that would be very important for a lot of people.
@@speedstone4 I'd like to debunk you on two fronts using a sample size of 1, which is better than none I suppose? One is that there is no such thing as vit d deficiency. There most certainly is, and it is not fun. Two supplements work, because I have actually blood test pre and post supplementation. Now does everyone need it? Not really. But fundamentally it is relatively harmless with a very high toxicity threshold and with significant symptoms caused by deficiency, it makes sense to generally supplement. Now I don't know what to make of it but anecdotally my last major depressive episode was when I was dangerously deficient in vit D.
“Somebody offering you attention, listening, saying something soothing…” Indeed in psychology and the behavioral health field we call this “the therapist effect” and it’s our interpersonal version of a placebo effect, against which any research evaluation of a specific intervention or psychotherapeutic technique must be compared to claim increased efficacy versus “treatment-as-usual”. Because we know that really does help most people at least a little bit, no matter what else may or may not be going on.
In the VITAL study, the treatment group was given 2000 UI daily but the placebo group was allowed to take 800 UI, plus most of the participants already had sufficient vitamin D levels to begin with, so it's unclear if this actually *says* (as you state) that vitamin D is just a bystander. The primary endpoint was about cancer, but they only followed up people for 5 years, which is a very short time. There are several limitations in this study, but the fact that it didn't focus on people with vitamin D deficiency is even properly acknowledged in the conclusions of the ancillary study to VITAL that focused on frailty ("Effect of Vitamin D3 and Omega-3 Fatty Acid Supplementation on Risk of Frailty - An Ancillary Study of a Randomized Clinical Trial"): "These results do not support routine use of either vitamin D3 or omega-3 fatty acid supplementation for frailty prevention in generally healthy community-dwelling older adults not selected for vitamin D3 deficiency." I generally agree that low vitamin D association with many diseases is not a cause but more likely a consequence (if your health is bad, you end up spending little time outdoors, less sun exposure, less vitamin D). But going from that to saying that having low vitamin D levels is not that important (is not really a vitamin!) is really a stretch.
Love your pivot into being a video essayist! Although you aren't quite up to Hbomberguy length yet, so keep working at it (yes I did watch it all - and I want my get well quick pills dammit!)
Your videos are simply the best (and most entertaining) presentation of health and medical information and debunking of myth and misinformation currently available. Thank you thank you for your contribution to evidence-based living.
Myers Briggs personality test is basically astrology for science majors. Yeah, it is not scientific but it appeals to my love of giving tests and filling surveys.
i've basically got to listen to every one of medlife's videos more than once to glean what i'm meant to be gleaning, but like. gosh am i glad the videos are being made
When I mentioned this quote on Reddit one person responded with “this is so vague it’s useless.” And it is vague. But it shows that people want a specific solution to health and that doesn’t exist.
@@nekowolf583 that's so interesting! I interpret the "vagueness" as a broadness in which people can find their own specificity. "Food" and "mostly plants" can be a lot of things (although i also interpreted that to mean, the closer to unprocessed the better) but that leaves it up to the eater what kinds of things they like to eat. And "not too much" is also personal. You know when you're full or not!
@@shellderp it's generally good, science based advice for most people. Eliminating most meats from my diet has been great for me 🤷🏾♀️ but if the opposite works for you, more power to you
I'm one of those awful patients who always asks my doctors how the treatment their doing actually works. But now this is making me rethink asking about the mechanisms for things. Though, my main consultants are quite good about citing studies and evidence.
There's nothing awful about wanting to understand what's going on with your body, even if it's just for your own peace of mind. I always ask questions because it helps me remember things and motivates me to stick to the treatment plan.
Knowing the mechanisms of action is important - it's just not indispensable to medicine. There is a surprising number of widely-used therapeutic options whose mechanism is unknown. Still, it's a great thing that you're interested in how your treatments work!
If I understand correctly, knowing the mechanism may help you experience the placebo effect, which can improve your health outcomes in addition to the physical effects of the treatment. You can still benefit from asking for an explanation, while keeping in mind that there may be insufficient evidence to support the theory.
The main takeaway from the video shouldn't be to avoid questions on how it works, but instead to *also* ask if it has been shown to work well, regardless of how it works. Knowing both is great, and more beneficial than either one, so you sure can keep asking why :)
Wooo you talked about ORBITA! Thanks for making such a great video. I've needed this exact video on the mechanistic bias for years when speaking to people. Now it'll be so easy to just link to this.
I think you may have missed the point about children masking (it's fine, most people did): they *are* a very low-risk group but many *teachers* are in high-risk groups and they know how often kids get them sick. My mom, who was a teacher at the beginning of the pandemic and is in her 60s, absolutely did not want to return to in-person schooling for the very reason that kids wouldn't be consistent at masking but she sure as hell was going to enforce it as best she could when she didn't have a choice. It wasn't about keeping the kids healthy, it was about keeping herself and her colleagues healthy.
Being in an enclosed room with 25 people all breathing for an extended period of time makes the masks meaningless anyway. They aren't breathing into a filter that is absorbing what they are breathing out. There is just a barrier that stops some of what their breathing from going too far away from them, but that breath is still there in the room and does circulate. The mask only helps for very short term interactions.
Hampering the immuno and social development of children who need facial cues, using masks that are only rated down to 0.1 microns (at best), equals nothing but lost life years for the kids. Loss of educational quality reduces lifespans, and kids have a narrow developmental window to learn facial cues, without which the kids develop anxiety disorders. Take it from someone who found out that the most expensive N95s fail against grain dust (which is mostly finer than coal dust, but far larger than viral aerosols). Even when the masks were taped on to reduce air-gaps, Brownian Motion carried that grain dust right through and turned my snot black within half an hour. Masking against a virus that spreads primarily through air conditioning? Superstitious nonsense. Watch what actually happens when someone sneezes into a mask, versus when they sneeze into the crook of their elbow. Then look at foggy glasses, or at people walking in the cold like steam trains, and ask “is it really better to shunt our exhalations higher into the air where aerosols linger longer?” And don’t even get me started on the fancy new graphene masks. Whenever that type of mask is cheaply made, it crumbles inside the fabric, then easily escapes into the air or lungs. Might as well wrap your face in a coal miner’s hankerchief.
@@WisdomThumbs masks don't hamper social or immune development in children. they may be pointless because kids are not consistent, but that doesn't make them harmful
@@platedlizard This is basic pedagogy. Depriving young kids of the ability to see and learn cues outside their immediate family is directly linked to increased rates of emotional and psychological disorders. It's almost as harmful as depriving them of language itself. And for nonverbal kids who are too young for precise fine motor control, *facial cues can be their only method of communication.* Have you ever taught a child with a speech impediment when one or both of you are wearing masks? Try it, you'll catch yourself exaggerating the mouth and tongue movements to *show* the child. It's even more important for infants and toddlers to see the mouths and faces of adults during social interactions. That's foundational to cognitive development. This process is weak at first due to newborn eyesight, truly begins around month 1, increases around month 3, and by month 6 (once they have a few phonemes down) they watch mouths intently. Their exposure to facial cues remains developmentally critical for 6-7 years. Missed development in childhood leads to issues in adulthood, with one example being increased rates of drug and alcohol dependence. Do you see how that poses problems for kids who are surrounded by mouthless people for 2-3 years? I'll quote from Child Development Vol. 60, No. 2 (Apr., 1989), pp. 411, "Children's Integration of Facial and Situational Cues to Emotion" (Hoffner, Badzinski): "The ability to interpret emotional communications has an important influence on how people perceive and interact with others (Buck, 1984). Children's skill at decoding nonverbal cues affects their ability to empathize with others (Feshback, 1978) and is important for successful interpersonal relationships (Feldman, White, Lobato, 1982.)"
Wow, I did not expect this video to expose one of the biases I myself have been guilty of, since I'm generally decently well educated about scientific methods. Even as I'm typing this comment I'm becoming aware of more topics I may simply be wrong about due to them making sense to me and it's kind of scary. A problem I tend to run into a lot is that the specific things I would like to know about simply have no associated clinical trials (yet), or that those that do exist have major flaws such as very small sample groups etc. And despite the lack of evidence (in any direction) I still need to make risk assessments etc. or am simply trying to figure out explanations for certain oddities which don't make mechanistic sense. I think I'll still have to run with "the best explanation I have" even if that's just a mechanistic assumption in cases where no good evidence exists until there is evidence to falsify any of my models which will then force me to improve them. So, while I don't think it's wrong for me to think the way I do, I certainly have occasionally put too much stock into things which make sense to me.
thank you so much for this amazing video. it’s great you mentioned andrew huberman, even if it was only in passing - i just finished a neuroscience degree and he annoys me to no end. it’s just common sense advice like “sleep and eat well” but cloaked in neurobabble nonsense like “dopamine fasting” as a way to sell it to people who just aren’t that keen on following simple but effective advice.
On the other hand "eat well", "sleep well", "exercise sufficiently", "spend some time outside" are indeed common sense, but also utterly useless on account of being super vague. The added value of Huberman's podcast is that he distills the research (which may or may not be correct; as a layperson I have no way of verifying it) into actionable protocols. Which types of exercise should I do? How much of it? Well, he clearly breaks it down: if you wish to achieve X, focus on exercise of type A; for Y, focus on B. And this is the amount of exercise you need to do to reap the bulk of the benefits; after that, you reach the territory of diminishing returns. Great! That's something I can work with! That said, he does tend to be pretty long-winded (and trust me, I am aware of the irony, coming from me), repetitive, meandering, and his podcasts have gotten so long that it's impossible to keep up with. I'd have preferred if he'd stuck to his original format of approx. 90 minute episodes, and doing multiple episodes on the same subject to cover all the important aspects. It's not like his is the only podcast worth listening to, and we all got jobs and chores and social obligations.
...and what a great magnum-opus it is. Thank you for the amazing overview, and highlighting how important critical thinking and healthy scrutiny is. I hope you have a great New Year's eve, and all the best for 2023.
Excellently written and presented. Thank you. This really made me realize some problems with my own thinking and question advice I had previously given to others with, what turns out to be, way too much confidence. All while believing myself to be smart and well-informed. It's really easy to overestimate yourself
Sometimes I think learned people are easier to fool partly because we spend between four and eight(!) years going to school and learning things that are correct and yet counterintuitive. So we start to think that if something is counterintuitive, it must be correct. However, if it smells like bullsh*t, it's usually best to assume it's bullsh*t until rigorously proven otherwise. I'm reminded of a comment attributed to Carl Sagan: "Yes, they laughed at Einstein. But they also laughed at Bozo the Clown." Thanks for prompting me to finally get the treadmill I've had in my Amazon cart for a few days. The cr*p weather part of the year is coming up, and I have zero intention of slipping on ice and breaking a leg in the service of good health, so I finally figured I should just buy one of the stupid things.
It's not the point of this video, but mechanistic research is still an essential part of medicine. If we only conducted randomized controlled trials, you wouldn't come up with the drugs to test in those trials. It's not possible to test every molecule in randomized controlled trials as that would be both unethical and unfeasible both logistically and financially. Mechanistic research provides rationale to design those trials. I think this is important to remember.
Awesome video, which really got me thinking about my own biases and how I look at my own health or experiences within my own body. I think, as a layman, I often go that "mechanical" route of explanation. However, as soon as I read an actual medical paper I go: "huh, it's much more nuanced/complicated than that." I also started paying more attention to papers that admitted they didn't have all the answers, but more like in a "that's super confusing and weird but we don't know why because we actually don't know that bodily process that well" way. I feel like some researches really need a working explanation but I guess a lot of research is just trial-and-error? (I don't know, I am not a scientist lol) I was also wondering as you explained how vitamin d is a bystander/marker for other things and you mentioned the extra heartbeats, which you said are extremely common, what are they a bystander/marker for? Would love an explanation for this! Thank you!
Some bystanders are like looky-loos at an accident scene....not there for any particular reason, but sometimes they get to be in the news photos.... ;)
THANK YOU for your support in 2022. This Christmas I'm donating my sponsorship fee to charity via GiveWell because I know it'll help those in need. If you can join me in giving something, please do - anything helps. Have a wonderful festive season! www.givewell.org/medlife
Great video. I thought of so many funny responses while I watched this on nebula & by the time I noticed it on yt I'd forgotten them 💀
The problem with the C-19 shots is not the science behind the shots. Rather, it's the vehement distrust of the people behind it. That's all.
I'm not trying to be woker than necessary but why does a charity spend money on youtuber advertising? To me it doesn't inspire confidence they use their funds sensibly when they spend it on UA-cam ads...
What a kind endorsement of a hyper-effective charity! Good for you!
All the most sick people have lower vitamin D levels because they usually most in bed in hospitals or home and most beds aren't under direct sunlight.
When I was doing my biochemistry master's on the first day my work mentor asked me to guess how a particular biochemical mechanism works. I gave him one and he said that the explanation was very good, reasonable, and plausible. It was wrong tho because of factors I did not know or could have reasonably known. I learned then that no matter how smart you or your explanation are, reality does not really care.
Lol, yeah. The everyday reality of labwork is that biology doesn't care about your cool hypothesis.
I'd refuse reality and design a whole new biochemical pathway, with novel enzymes and mechanisms, proceed to build the genes related to their expression (and regulation nonetheless) and finally get a break together with a Nobel prize or two.
Same conclusion I reached after every chapter I read on molecular biology
So true really
I myself am constantly taught to create arguments that are reasonable and defendable even if flawed.
I am not educated in the military sector but even with my limited knowledge, I can make a plausible argument that all the problems in my life can be attribued down to the military because I one day mentioned a technology they are currently secretly working on and they want to silence me. Why don't they just kill me? Because if they do then it will be suspicious if I-saying they are working on a secret technology-suddenly die!
I can even bullshit my whole way to diagnosing a random person with adhd or autism even with my limited medical knowledge because I can create plausible arguements
@@gabrielsb3419 I'm more on the chemistry than the biology side, but biochem kicks my three letters six ways till sunday...
Pretty much any time I think I've gotten a (loose) handle on wtf is going on another bombshell gets dropped on my head and I realise how little I know.
There's like... two things I'm reasonably sure of? Fructose and seed oils are probably not great for humans to eat, but why exactly is this long, long, _long_ trip into biochemical pathways ;_;.
And that's like a teeny tiny slice of the ridiculous insane world of just human metabolism ;_;.
There's a joke I heard a while back that I really like that came up in a discussion about cognitive biases and increasing awareness about them: "The only critical thinkers left are people who know they are not critical thinkers". Knowing about a cognitive bias in large part is knowing how blind we are to them when they are our own.
Thiiiiiiiiiiiiis.
I don't suffer from cognitive biases. In fact, I quite enjoy them!
@tallskinnygeek BASED
Is that based or biased?@itsmyright2229
i know the phrase sounds cool but it doesnt make much sense
I was at Eli Lilly's launch of Xigris in my country. Champagne, fabulous food, and a popular singer giving a concert. Then about two weeks later I had a patient who I thought would benefit from this almost miraculous drug. She was in severe sepsis, and on 4 vasoactive drugs. Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately. She was weaned off the vasoactive drugs in less than a day and extubated 2 days after. The drug was a success. Afterwards we had no problem getting approval for its use. It was similarly useful in at least two more cases. We were believers, and when we saw that it wasn't universally effective, and caused some significant side effects, we were profoundly disillusioned. We bought into the hype, and were reassured by our own first experience with the drug. Lilly's explanation of the mechanism was completely bioplausible.
Dr. Paul Marik has used H.A.T. (hydrocortisone, ascorbic acid, thiamine) therapy to greatly reduce sepsis.
I looked this drug up and read its history.
A number of years ago the rules changed about drug companies giving sponsored dinners\parties and whether CMEs could be given for these presentations. Basically CMEs are not given for most of these type of presentations.
The health care system privilege money shot: "Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately."
I just watched the vasopressor trap video..
You started off your story with, "champagne, fabulous food, and a popular singer giving a concert. "
Those are all red flags.
Obviously they were trying to trick you..
"When you know a bit about metabolic pathways or NTs or cells it's actually easier to concoct things that confirm your beliefs"
Every student of physiology felt this in their bones
Or you spend years getting to know how spectacularly little you know and getting the slightest sense of being sure stamped out.
Yes Sherman, or to look at it another way, "A little bit of knowledge is a dangerous thing."
your emphasis on human contact and concern being what is actually helpful in many pseudo-therapies is so accurate. we need each other as humans and when we feel lonely and depressed, that can manifest as physical symptoms. sometimes what we really need is touch and attention - someone to put their skin on our skin and listen to what's burdening us. the most helpful things my doctor has ever done to treat my chronic illness are to listen to my struggles, give me solid advice, and give me a hug. of course the medicine and lifestyle changes contribute to reducing the bad things but the social components of treatment help maximize the good things.
we need each other and we can save each other.
Very true!
I once had an interesting experience at the dentist: I had to get a root canal treatment and it was unpleasant and painful.
At some point, the dentist put his hand on the side of my face to stabilize my head and it made everything better. This warm pressure made me feel safe and comfortable and that altered my perception of the pain. It was easier to endure.
And we know that feeling cared for reduces the amount of stress hormones in your body and has other measurable physiological effects (on top of the psychological ones).
Modern medicine needs to take this knowledge into account. "Holistic approach" is not just a buzzword.
But of course all of that is being ruined by the profit motive of capitalism.
non sexual physical contact has pretty much become inexistant in our society, appart from parent/child, and that is really scary to me
It is one thing to say that this kind of pseudoscience placebo effect may help in some instances, it is a completely different story to market these practices to the mass
Here's my take on the subject of human decency and caring: When you're looking for a family doctor, NEVER get a doctor older than 45.
After that age, they've grown so used to death, and are so utterly numb to their patient's concerns that they are just counting the days until retirement. They've lost all passion for actually helping people, and are just going by muscle memory. The other day just to see if I was right, I asked my doctor for a random drug saying I heard it would help with weight loss. Without even looking up from his notepad, he said my pharmacist would have it shortly, and he didn't so much as ask me where I heard about it, or if I was experiencing any symptoms the drug was prescribed for.
Yyunko, friends do hug. Putting an arm around the shoulder of a friend is also pretty common. That's how it is here, at least
The Return of the King
The anti liver king
Liver King? May the sun ever shine on his scrotum and his testosterone forever swell
Cardiac King
King of hearts
@@spreekstem 🥇
What a wonderful overview. The mechanism fallacy is a great little label for it. My Christmas wish would be for my "independent researcher" parents to watch this and absorb its message, but perhaps as a direct result of growing up in a household filled with magical thinking, I no longer believe in miracles. But you were so even-handed and cool headed in your handling of the subject Rohin, I hope it does reach a few people who need to hear this message!
Thanks mate. Weirdly enough I was talking about you at a party today as a friend who is prone to flights of fancy has decided to write a book about typefaces 😂
Here's something that bothers me about the "independent researcher" archetype, though- it's often used by medical professionals to paint any patient who contests their way of doing things as similarly deluded by quackery.
I'd been failed in my tendinopathies by GPs, surgeons & PTs who all pushed treatments not supported by science, before eventually solving the issue through simple load management and a single heavy load exercise.
I'd been failed as a transgender individual by a specialized clinic that still operates on myths like that spironolactone lowers testosterone & woefully under-prescribes estrogen for proper androgen suppression despite minimally elevated risks with higher doses through non-oral RoAs.
As a person with ADHD, I'd been failed by psychiatrists who prescribe the expensive 'Vyvanse', a simple rebrand of 'Dexedrine' that is functionally identical save for an attached-protein making it only able to be used via oral RoA, and makes me feel just as depressed when it wears off, as Takeda Pharma pushed that it was safer while conveniently collecting billions on a new patent. Similar was true of Adderall, a drug brought to market under a new patent through the inclusion of levoamphetamine- a chemical that had been indicated as *not* of therapeutic value decades prior due to its actions on norepinephrine making it bad for both the heart and anxiety. Meanwhile, mentioning the medication Desoxyn- known under a more popular name that might get this comment censored- has been met with shocked looks and abandoning me as a patient, despite how its lowered action on norepinephrine makes it more heart-healthy and its greater specificity for ADHD symptoms makes it have few side effects at the therapeutic dose. Stigma dating back to World War 2 dictated these doctors behavior more than the actual science of the chemical.
And yet- whenever I've brought any of this up to providers- I'm seen as the deluded "independent researcher", despite how I sourced all of my information from a variety of journals & Science-based Medicine journalists, all in response to a medical system that was failing me.
@@made.online2149 Holy shit, are you me? Literally everything you just said is exactly part of my own experience dealing with the medical community, topic for topic.
@@made.online2149 holy shit you might have just saved me $300 a month😊
@@MedlifeCrisis 07:40 Yes they are testable! a lot of work but they can be! Nobody will bother as we know theres no point it doesnt work! If they do dance with music near the plant it might make it grow better! :)
That thumbnail is disgustingly good. Well done sir 👏
I outsourced it for the first time ever! So I’m glad it was worth it! I suck at thumbnails
@@MedlifeCrisis Definitely got me clicking straight away 👌
I thought it was an ad when it showed up on my feed 😂
Yep. Amazing
@@TommoCarroll Oh, I guess I need to check the thumbnail now, didn't even see it yet. I just see a Rohin video available, I watch it. =)
12 years into my self education of science in all it’s glory, and I was 100% unaware of my own mechanistic bias, in fact, i believed it to be a very promising indicator. Even though I was very much into evidence based medicine, I was stuck in a mentality of “it makes so much mechanistic sense, it’s clearly going to pan out in all the trials that are sure to come.” Thank you so much for helping me along in my journey, you may have saved my life or a loved one’s, because they or I will get very unwell eventually. Thank you sir
I agree.
Science is ultimately a process of becoming less wrong, so all of our theories are always at all times limited and will miss certain things. They are a basis from which to start an investigation or to try to understand something but always come with the caution that usually reality is much more complex. Also it's all dependent on how well evidenced the theory is, there are some theories that are so rock solid that you can dismiss things solely based on them but there are others that are much more limited in scope and sure-ness (not sure what to call it but like how clearly you can predict an effect from a cause).
science shouldn't see itself (ego) as right or wrong but proven or unproven. to help seperate the ego of the dr from facts. i would be hard pressed to find a dr. who would say "vitamin D" is not doing anything. but as a primative mammel it makes me feel better to go outside everyday. but a dr. can't make person go outside. these are the problems we need to tackle
Omg, what a great video. I'm a med student and I could never make sense of why anyone ever said "stenting is effectively useless" when I knew it is a life-saving procedure for ACS. I didn't realize people used to just stent random people on the street just because they wanted to.
As someone in physics, I think the idea can be extended a bit further. The problem isn't just that people believe in things that are bioplausible (or just mechanistically plausible, in other fields). The problem is that we never truly have a perfect working model. If one actually has a perfect simulation or model of any system, then any mechanistic solution/therapy/fix that satisfies the model ought to work; however, we're never working in that perfect world, even in physics, and other fields just get harder and harder to model as we move away from physics.
In other words, the problem isn't that we believe in mechanisms, but that we mistake out intuition for actual perfect models of reality. A nice label that's not field-specific might be 'intuition bias'. I see this all the time in physics, and honestly, the longer I've been in research, the more I find that I have to fight this bias, because one develops more and more intuition around models that are not exact reflections of reality.
I think this is also quite related to the current state of science, and how in the past, a single smart bloke could indeed revolutionize three different fields with mechanistic insights, because something like Newton's law of gravitation or Darwin's evolution, figured out mechanistically, makes sense and works perfectly for the understanding of the time. These days, models are so insanely advanced and the boundaries of science pushed so far that it requires entire lifetimes to meaningfully expand a single niche. There is no way to directly intuit this stuff anymore, best you can do is make some good hypotheses to be tested. But many get stuck in the old way, after all, it worked for centuries before, didn't it? Everyone is taught that you could become the next Genius of our Time, rather than the reality of contributing your study to many huge groups set up to probe topics far too vast for any one person to fully plot out from cause to effect.
This just reinforces my notion that the vast majority of science has probabilistic conclusions than absolute ones.
Because we can't isolate, let alone IMAGINE, every variable contributing to the experimental outcome. But the effort can still be useful/important to build upon w/ more inquiry (go from a state of incredible messiness to something more organized). To attempt to make our models (and interpretations) more comprehensive, despite the impossibility of perfection.
AKA "The map is not the territory".
A good example are the TNF inhibitor class of drugs, Humira, for example. TNF is an important cytokine that modulates immune responses. However, in some autoimmune inflammatory diseases, too much TNF is produced which leads to damage to healthy cells. TNF inhibitors were designed to bind TNF and thus prevent some autoimmune diseases. But it became clear in clinical trials that these drugs rarely cause or worsten heart failure. This is unexpected since, mechanistically, there is no reason to suppose that this should be the case. Still, it happens, and indicates an incomplete understanding of the role of TNF.
Totally different context, but it's actually a kind of bias that the arts struggle with constantly as well, especially visual arts. In order to recreate a believable model of reality you have to back engineer from all the automatic image correction and manipulation the brain performs, while still understanding that either you can know things that your eyes tell you are false (relative colour issues for example) or that would be devastating to your other functions in life to truly undermine and break. Thinking especially about where crafts intersect here, where over time experienced workers build up incredibly sophisticated internal models of physical understanding that may entirely bypass the concious thought parts of the brain, being encoded somehow as some sort of artificial instinct almost. It can be a very structural issue, at least to my knowledge, but my perspective from the arts actually gives me a lot of hope for compensating for this problem in science, once the awareness of the distortion is there, the opportunity to change it exists
While I watched this (commercial-free on Nebula, so thanks for that), I kept thinking of all of the folks I know who really need this information. As a retired scientist, my love of evidence is, well, evident. It drives my friends a bit crazy, but when they doubt the veracity of anything "sciency" or medical, they always ask for my assistance in researching the facts.
I want to thank you for finding the time to make these humorous and educational videos. You truly are one of a kind and have a unique perspective. I wish you had time to produce more, but I do understand your time constraints. Have a lovely holiday and joyous New Year.
Did you take the Covid vaccine and boosters ?
@@edcarson3113 All of them. I got the Moderna about 6 weeks after it was released and and have had 4 more, all without a single side-effect. Not even soreness at the injection site . I have not had covid, nor have I had a cold or flu since December 2010. Good hand hygiene and strong immune system 😀.
@@stephaniehyatt309You don't know how lucky you are that you didn't have a single side effect!
@@vivianloney None of my friends or family had side-effects, and only one co-worker did (out of dozens). So I don't consider "normal" to be lucky. Lucky is when most people have side-effects but you don't. Just sayin'... BTW, to avoid a sore arm, get injection in dominant arm, massage immediately after injection, then use arm as much as possible. Learned this about 15 years ago from a nurse giving me my annual flu shot. This year, I got both at the same time!
@@stephaniehyatt309 What a weird way to define the idea of luck- I don't think the concept of "good outcome of a situation of chance" has anything to do with normalcy. And side effects weren't abnormal. Something like 30% of people got side effects other than a sore injection arm after the vaccine.
As a philosophy major - I may not entirely agree with Popper, but it's incredibly refreshing to see some philosophy of science brought into this kind of convo, very useful and great job
I'm satisfied with the note that there are criticism and like 100 years of philosophy of science after Popper.
A lot of philosophy inclined scientist often take Popper criteria as the end all of the demarcation problem
@@gregdesouza17 so what are the most important first next steps we should take?
"As a philosophy major"
lol
It's interesting how little the philosophy of science is taught in scientific degrees. I'm aware of Popper, but only through reading some Wikipedia articles after I finished my physics degree. You would have thought at least some discussion about what it was we were actually studying would have been worthwhile!
I'm curious what about Popper you object to? My main takeaway from Popper is the principle that you can't conclude something from an experiment that was not directly observed in the experiment. But this seems too high of a standard for most. Science stories that make the news are almost exclusively stories where the claimed results far exceed what was actually observed.
damn this was actually a really important video to make... as a junior-level chemistry undergrad student I certainly have a tendency to see myself as an "expert" among my friends and family who have no formal science background at all, and it wasnt until this video that i was really able to finally formulate the thought that maybe my ability to reason out potential mechanisms of cetain phenomena isnt actually as valuable as i thought? and in some cases may actually be way less valuable than my friends' and family's approach of just reading news articles about studies on things? i can't imagine that im the only person who's like this and who needed to see this video, so thank ronin
I think it's easy to fall into that trap and when you learn about science you'll keep falling into it and pull yourself out, not because you're arrogant but simply because you're hyped about suddenly understanding a new thing and being able to describe it precisely and make predictions. And of course you want to share that knowledge both because it's really cool but also because it might be able to help those around you. And it's really scary because you know that those around you will likely see you as an expert simply because you can recite things they haven't heard about and take your word for things. There probably isn't any surefire solution here, like you can't always stop yourself from getting excited so you just have to live with the fact that you will make mistakes and say things that are wrong, and try to always stick with the evidence.
Since it is tangentially related to a couple of things you mentioned, I thought I'd go off about a pet peeve of mine: RCTs in social science. While they are the gold standard in medicine for good reason, I feel like we have imported them without realising that some of the key assumptions aren't satisifed. Firstly, double blinding is basically impossible: you can't not inform people they've been enrolled in a school, for example. Secondly, the external validity is much more of an issue because of huge differences in social context. Thirdly, there are bigger issues with dropout and substitution because it's just harder to keep people in social trials than medical trials. I could use this to say something about givewell and effective altruism, since they rely so heavily on these RCTs, but I'd need to look into it more. (Full disclosure: I also use Givewell but I need to investigate it further.)
Nice to see you here, love your videos 😎👍
Does research around diet fall into this category of not being able to be blinded?
@@le13579 I'm no expert but I guess it varies on a case by case basis. Some foods could be 'hidden' or made to look the same while others couldn't.
Another issue, of which you're very certainly aware, is how many social science research trial subjects are affluent, western university attendees, which is a very narrow subset of people who generally inhabit a shallow demographic pool...because universities are where research is being done (so I get it--I was a part of that machine). That leads to hugely imbalanced/skewed results that are not necessarily applicable to the outside/"real" world!
What does RCT stand for in this context?
Rohin, thanks for another great discussion! Worth the wait. My new favorite saying: The road to Hell is paved with bioplausibility.
EDIT: To say the ads that played during this video were ironic would an understatement.
Another legend appears!
This is the crossover I’ve been waiting for
I’d buy a shirt with that saying ! Hint hint
I was once by a patient's hospital bed when the doctor came by. We asked if a certain treatment could be tried, which would have made the patient more comfortable. The doctor gave an answer, which I thought weak at the time, but I now realise showed high training and courage: "there's no evidence that it works."
Depends on the treatment, if there's llittle cost and risk, there's no reason to deny it.
Not to mention, for new treatments to be found they have to be tried first, and if there's no interest in a treatment there'll be no funding for studies either.
Placebo effect though
Meh. Sometimes you get desperate.
I second Stee; it's not about whether there's evidence that it works. The question is whether the potential benefits outweigh the potential cost. No risk interventions should be tried willy-nilly, especially if the patient wants to try it. The only caveat is that the risks include opportunity costs, so make sure you're not forgoing treatments that do actually have evidence behind them.
If there's no benefit, any cost would be unnecessary.
I really appreciate your discussion of ICU patients. My mother was admitted thru ER to the hospital after being told her high blood sugar (diabetic for perhaps 20 years) was alarming on a cardiologist's blood panel. That night before going, she also had an issue of clear fluid weeping from her legs, fluid retention from congestive heart failure. The next morning we visited her in her ordinary hospital room where she complained about the taste of a potassium supplement she ended up not being able to finish. Later that night, she had a cardiac event and was found in the bathroom un responsive. She was taken to ICU and spent almost three weeks there while the doctors monitored and assessed every detail. By the end, after she had aspirated and was too tired from being constrained from bed, she made the decision for a DNR and halted treatment. An irony, her legs had fully healed in that time, so if one's observations were blinded to the liquid food and other sources of pneumonia that ultimately ended her life in hospice, her fluid retention and leg wounds had been completely addressed.
Thank you for your work, and sharing your voice here on YT. As a math student in college, I have huge appreciation for science, and often tell my nurses "I can tolerate anything for science" such as blood tests, nasal swabs, and throat scrapings. That month of being in hospital with my mother, I was angry and disappointed that science didn't have a perfect solution for her, but I still appreciate that having a way of telling that we're capable of wrong is the best part of science.
Ultimately, the human connection that her doctors had with us helped us come to decisions, and while I subscribe to a Diet-Zen "life is suffering" and agnostic approach to the afterlife which I don't think I could make the same decision my mother did, I am gracious to compassionate medical staff willing to talk to us and answer our questions.
Thank you, Rohin, for your time and work invested in this type of content. As a med student, I can still remember, when learning the basic sciences (physio, biochem), I thought that I knew so much and would eagerly await the time, when I become a physician and would be able to explain my patients their diseases and treat them based on my mechanistic understanding. Now when finishing my studies I am much more aware of the limitations of investigating such complex subjects as humans in health and disease with all kinds of variables possibly playing a role. Now my wish is not to be mechanistic know-it-all, but to be a prolific "reader" of research. In words of Siddhartha Mukherjee: "But most doctors don’t really hunt diseases these days. The greatest clinicians I know seem to have a sixth sense for biases. They understand, almost instinctively, when prior bits of scattered knowledge apply to their patients - but, more important, when they don’t apply to their patients. They understand the importance of data and trials and randomized studies, but are thoughtful enough to resist their seductions. What doctors really hunt is bias."
In charity too, interventions with plausible sounding mechanisms often turn out to have basically no effect. The economist Michael Kremer found that additional textbooks, flip charts and even teachers donated to poorer schools in Kenya had basically no effect on test scores when put through an RCT. However, de-worming drugs (to cure intestinal worms) had an enormous effect.
GiveWell tries to find interventions backed by solid evidence rather than just plausible sounding mechanisms.
For more on effective charities etc., I recommend the book "Doing Good Better".
Charity usually takes place from the perspective of the giver, not of the recipient. The idea of children being too sick with worm diseases to absorb education seems too disgusting for Western people.
An extreme example I like to make is that "Smoking is healthy, because it helps manage stress" - sure, many people certainly feel eased when they can finally smoke after a stressful situation. But that doesn't induce that we should smoke or even that smokers are less stressful
(I'm similarly skeptical about the alleged benefits of modest alcohol intake)
Great video, enjoyed a lot!
Ah, but tobacco has been tested in RCTs. It does work, and if you're dying anyway, it might be worth the damage it'll do. (Don't mind me, that's my depression talking.)
But in all seriousness, it's worth testing. Consider chemotherapy, which by all means is terrible for you. Or even surgery, the application of wounding a patient and exposing them to dangerous pathogens to help them feel better. As much as I try to keep primum non nocere (yeah, that's probably spelled wrong) close to my heart, it cannot be the only guiding principle.
Hmm, ah I missed that. I need to find another example then. Thanks for pointing out.
(My other point with smoking is that there are various other ways to reduce stress, and maybe tobacco can also be consumed in other ways that aren't that harmful. But still, if it indeed shows effect in RCTs then the key point with my example is invalid)
To my understanding, a lot, if not all, of the benefits of alcohol disappear when you correct for income (especially the supposed benefits of wine-it turns out the people who can afford to drink it regularly can afford better health care in general) and that a sizable portion of non-drinkers are abstaining because they previously abused alcohol.
@@er00ic Or abstain because of pre-existing physical or mental health issues. Yup. This was my immediate thought on hearing about that result. It doesn't mean it is correct though of course, for exactly the topic of the video.
I guess I have another mantra to add to my logical toolset: A plausible mechanism can only ever expand the solution space, never shrink it.
@@marenjones6665 if smoking is helpful because it reduces stress, you'd need to prove it reduced stress better than the gazillion things that reduce stress without causing lung cancer or other types of cancer
Also, afaik, if a stimulant is reducing your stress, either you have ADHD or the stimulant isn't reducing the stress at all, it's just reducing your craving and getting you back to the baseline you were at before you took up smoking
Thank you Rohin for once again providing content that bucks the algorithm by being both rigorous *and* entertaining. You're providing a service to society well beyond giving us all something to fill our evenings (but also that too!).
This is absolutely first class work. I have to say this is one of best pieces of content I've ever consumed on this platform. Thank you for the thorough work to produce this
So I watched this when it first came out. I just re-watched this and this time it really hit home. I think I am ready to "hear" this now because I just got so tired of chasing my mechanistic wellness tail. I just want to live as well as possible yet realize that eat well, sleep well, get a bit of exercise are the "real" secrets. The only thing I would add to that would be to have at least one good interpersonal relationships, because we are social creatures.
Oh, the Journal of Infrared Scrotal Science. JISS. I love JISS. JISS is my favourite medical journal of all time.
Goddamnit, Rohin.
It was originally an offshoot of the Proceedings of the National Academy of Sciences
@@aelolul Right. First you have PNAS, then comes JISS.
You apologised for the first mention of epistemology, as if it might prompt people to leave the video, but that was the scentence that made me think "oh I'm definately watching all of this".
I love it when I forget who I am subbed too and then they spring back to life with an hour long video that sucks me in.
Another great video. If only everyone had the capacity to listen and understand the meaning of this, the world would be a better place.
From my background, it's interesting to note that the mechanistic bias also shows up in realms that you'd consider very pure and logical! In software, if you want to optimize the speed of your code, it's really vital to have good measurement tools. If you just follow rules of thumb about what "should" make things faster, you might "solve" something that wasn't the bottleneck in the first place, or even make things worse. Especially when you get down on the really low level of machine instructions, it gets really really hard to predict what's going to ACTUALLY be faster without just trying multiple approaches and measuring what works best in practice. You'll have people insist things like "but my code aligns data on cache lines!" as if the performance gods are obligated to reward your rain dances, when a hundred other little factors like inter-core contention might make your code slower.
Ultimately, there's no proof except proof, and you have to be kinda stubborn about it. Rules and models can be very alluring sirens for the unwary.
The law of "Unintended Consequences" comes to mind with code along with "Well, it worked on my machine". :)
It was bad enough back in the days of "single function computers" running one program at a time. Today it's hard to guarantee that Microsoft won't release an "upgrade" (and your IT department roll out) that breaks/degrades you code without warning. I got hit by a couple of those.
And I mean we do actually know for certain how computers work because we built them, so this isn't even like medicine where a lot of the time there's something we didn't know that messes things up. It just goes to show how quickly a system can evolve to become so complex that we have trouble truly understanding it.
@@hedgehog3180knowing how each part works and knowing exactly how the will behave when put together and then used in a very specific way are two very different tho.let alone how a piece of hardware should work and how exactly it will work aren't always the same, especially as manufacturing isn't completely perfect.
Four minutes and six seconds short of a golden hour! The statistic that 90% of interventions are not evidence supported is stunning!
As someone with a fairly rare condition (Meniere’s Disease) the Cochrane reviews are universally depressing. Nothing reliably works.
See and this dovetails into everything else:
-I really like you know, "healthier" foods, but access to them isn't amazing where I live(I tend to subsist on frozen broccoli and green beans a lot)
-I can't walk safely in my neighborhood, there's no sidewalks and people go down roads at 65mph
-I try to sleep enough and prioritize my sleep, but I've had jobs call me in or schedule me for awful shifts over and over, messing up my sleep schedule.
I think within this is the part where we created an environment where none of these things a prioritized, and then we're having like, solutions sold back to us in marketing schemes because like you said "Eat a healthy variety of foods, Go Outside, and Get Enough Sleep" isn't much of a marketing plan.
Drew Gooden even came to this conclusion with his video on his Sports Guy Diet--that the food was good and helped him feel better, it's just not easy to market "you'll feel less like crap all the time".
An hour of Medlife Crisis before Christmas? Best Christmas gift I've received today!
No but seriously, thank you for all your videos both this year and before, you're honestly one of my absolute favourite channels and I always learn something new and get another view on your topics. You make me think from different perspectives and are a great teacher, and funny, entertaining and interesting to listen to!
You've made at least one biochemistry PhD rethink his biases, and for that I thank you deeply!
Only criticism is I would consider having longer breaks between the sections as it is quite a lot to take in 😅
Fortunately the sections are time stamped. I sympathise with the long length with such information density being a bit much
Having watched you for years now you have earned my complete trust. Other UA-cam videos I watch skeptically realizing that most of them are just commercials for something. But with you I take everything you say at face value and never give it a second thought. Thanks!
This was a wonderful video, I'll be sending it to a few people!
Thanks buddy!
Top notch. So valuable to get a contemporaneous medical perspective from an experienced, ethical medical practitioner; this also pairs nicely with the TedTalk. I remember listening to Huberman and Sinclair and thinking, "These guys are making huge leaps of logic", but doubting myself since they are both associated with some very respected educational institutions. I do like the NIH lectures and UCSF Mini Medical lectures. I will take a look at your recommendations as well. Happy New Year! I see your assistant has had some craniosacral therapy.
Didn't help, as you see; I think he needs a chiropractor. 😝
Easily held my attention the whole way through. Would love to watch more of your 'deep dives'.
Please keep making these long form video essays, they're incredibly interesting!
What a relief. Rarity of sense. Long live and keep going.
Thanks for the shout-out, doc! And great video! All the mechanism fallacy needs for ultimate podcast success is an expensive epigenetic test for it…
I... please don't, even in Jest.
@@marenjones6665 An epigenetic jest?
…sorry.
I'm addicted to placebos. I'd give them up, but my doctor says there'd be no point.
😝🤣😝🤣😝🤣👍👍
Wow comment 😊
You just won the internet!❤
Terrific video as always Rohin! I seldom comment, but as a student of social sciences I actually had some thoughts about both the demarcation problem, and the marketing-lingo of modern pseudoscience. So I thought I would put my two cents in.
First, while I think it is very good that you put in the distinction between clear vs. messy sciences in the sidenote to delineate between sciences that benefit from mechanistic modeling versus other sciences, I think it is also important to reflect on what we mean by "science". Because the demarcation between science and non-science is often (as you mentioned) murky and unclear, but it is also littered with questions of institutional politics, _scientific_ methodology, and ideology to maintain a sense of objectivity that defines science for both scientists and the public. This is not to say that science is doomed of course, only that every time we speak of science and its pseudoscientific counterpart we reenforce certain narratives about science and scientific objectivity (the jargon term for interested parties is boundary-work). This is actually vital to the creation of new science and scientific fields.
Second, I think that the argument made towards the conclusion of your video about sexiness of sciencey-explanations could be understood as a part of larger cultural trends. Specifically that the sexiness is precisely the problem we are seeing in large aspects of society. From social media spectacles that turn out to be marketing ploys, to images of bodies that are heavily edited, to these bio-plausible but pseudoscientific arguments. Instead of wading into the often complicated endeavors to accumulate new knowledge, we get a simulacrum of a scientific argument. A watered down, but effective marketing argument for a certain treatment or diet. It would make sense that the larger societal shift in mass-media, economics, and politics would also trickle through to areas in academia and medicine. The problem you are describing in medicine or science in general is also a cultural and political one, I think. But those are just some inputs from my social science perspective which could make some sense to stuff like this.
His friend thinks he’s hip but it’s all in his head
I've just set up a monthly donation to Give Well.
Thank you for your suggestion.
And thank you for your informative, entertaining videos. My favourites are still the ones with your darling baby boys.
This was great, really opened my eyes to the mistakes I was making. I have major depressive disorder, and I and my providers have hit that point where we're throwing stuff around to see what sticks. Since brain science is equal parts poorly developed and deeply complicated, it's been a ride. Recently went down the folate wormhole and did not come out unscathed. I think I'll go back to looking at treatments that improved mood in RTC with no clue as to why. Also still working the basics.
Give carnivore a try, do your research and you will find that it helped a lot of people, while my depression wasn't severe it worked for me.
He's practically saying nothing works and if it works for you - you must be a biased fool. So I don't see what you heard (into) this absolutely ridiculous rant.
In my own travels on that patjway, I found that a classically balanced diet was having a profoundly negative effect on not only mood, but the effects of medications. Abandoning that and just making sure I get a reasonable amount of various nutrient groups in rotation over the course of a month or so, restored function to my medications and some sanity to my life.
Go figure. Not everything works for everyone, but I do know that going overboard for any one thing is generally a poor idea.
Good luck; suggest going back to basics, and work with what successes you can find to light your way.
@@chickenlover657 I saw your other comments and you seem to be kind of defective
@@autoteleology Well, I'm responsible for what I say, not for what you (mis)understand.
For a succinct description of our cognitive biases, I recommend the book "You Are Not So Smart" by David McRaney. There's also the classics by Ben Goldacre: "Bad Pharma", "Bad Science", and "I Think You'll Find It's A Bit More Complicated Than That".
I was just looking for books like this. Thanks for the recommendations!
Goldacre's stuff is great. Informative, while still an entertaining read. Will try McRaney, thanks for the hint.
Ben Goldacre is an entertaining read, up till the point when you realise that the bad science he is exposing has killed people. Then you realise it is serious.
Ought to be required reading.
@@andrewharrison8436 Ah, don't be such a downer. Hasn't killed you or me yet, nor is there a shortage of people ;) Just my joke there...
My point is that it's a good thing that Goldacre presents the absurdities in a half-joking way. It's hard to get people interested in serious stuff, their lifes are usually full of that sort of thing already. If you want to raise awareness for a problem, providing a bit of entertainment while you do is a good thing. It helps the cause by bringing entities on board whose only interest in the problem is to make some money out of it (meaning publishers and the like).
@@andrewharrison8436 Phil Plait's 'Bad Astronomy' is along a similar vein. It killed people too, albeit usually for the science being perceived as heresy against the Catholic church!
Thanks so much for this long video.
I know there's dinner virtue to editing down to Tom Scott sized single topic videos, but I'm very happy to listen to you talk for an hour
Truly delightful to listen to your well collected thoughts on these subjects. You have a broad audience. I watch every single video. Thank you.
I forget who it was attributed to, but there's a quote that summarizes this mechanistic bias nicely: "In theory, there's no difference between theory and practice. In practice, there is."
This is an amazing video. This should be taught in 1st year in all universities so that students get an idea of how susceptible our brain is to such fallacies. Thank you for making this, I've been watching you for sometime, but with this one you earned my subscription. Very well thought through and presented. I'll be using some of your arguments next time a relative/friend comes up with these kinds of ideas again.
I assure you there are plenty of schools teaching this stuff, and the students are snoozing through class and then going back to the dorm and whining about how much they hate that stupid stats/methodology course. You can lead a horse to water...
This is your best video so far. Very watchable - barely noticed it was almost an hour long.
I have ectopic beats and they can be really horrible. It’s scary to think that if I was diagnosed 10 years earlier, I could have been put on a medication that was possibly life threatening.
Just for clarification, it was in patients who’d had heart attacks. But your point remains, people had strange ideas about ectopic beats even quite recently.
Givewell seems like the organisation I have been hunting for for years- thanks so much for introducing me to it. Great video, really good for grounding the ever so excitable mind back to EBM. Also now you've nicely condensed into words why I dislike medical influencers so I can feel smug when they appear on my screen- thanks Rohin!
Just happened upon this channel: This video is great! I like his style 100% and his approach to science also a lot: Mechanistic explanation DOESN'T equal actual effectiveness.
An mechanistic explanation is just that: a POSSIBILITY. Not 'true' untill proven right, as in an actual convincing trial.
Thanks dude. You got a new subscriber.
Really happy to see you mention Popper when you talk about epistemology. For an even more modern take which further develops Popper's, I highly recommend "The Beginning of Infinity" by David Deutsch; it's a remarkably rational and insightful presentation of how and why progress in knowledge is possible. He also has a paper, "The Logic of Experimental Tests, Particularly of Everettian Quantum Theory" which is freely available from a link on his webpage. You can skip over the quantum mechanics stuff and just read the bit about experimental testing. In my opinion, David has the most brilliant theory of the philosophy of science to date, compared to a lot of other stuff you might find (Bayesianism etc.)
A lot of people seems to think science is about "right" and "wrong" - so that one party can go say "hah! I was right - told you so! (and by that I also imply you are an idiot)".
The whole idea is prediction. We do not need to "prove the earth is a sphere" so flat earthers can be mocked. But using a globe model of the earth lets us make useful predictions - that helps us in anything from metrology to navigation.
@@jarls5890 That science is only about prediction is actually one of the misconceptions David corrects in his book. In short, what science is about is seeking "good" explanations; an explanation that is hard to vary (changing the elements of the explanation) while still accounting for the phenomenon it purports to explain. What is and isn't a "good" explanation also depends on the totality of our knowledge at any point in time. The "flat earth" theory is a "bad" explanation because it conflicts with many other things we know of. For example, we know from physics that the gravitational force is spherically symmetric, which would pull stuff into a ball, not a flat disk. David also talks about how science is problem driven and conjectural; it always starts with a conflict of ideas, something you didn't expect or expected to be otherwise, and solutions to these problems are guesses, bold hypotheses which can be criticized and altered until a tentative solution is reached. He also has a TED talk on youtube that is worth watching.
@@Daniel-vu7pi I see no conflict here. Deutsch's "A bad explanation is easy to vary" is perfect for scientists and those who "believe" science.
The problem with it is when talking to the less scientifically inclined - or the ones who straight up distrust science - and especially distrusts scientists (and very much so if a scientist gets to define "good" and "bad").
I can't believe my layman attempts to understand (what I now know can be conceived as) the Everettian interpretation and experiments, testability and our subjective experience work in that framework without stumbling into anthropocentric Deepak Chopra territory has been spurred yet again by a UA-cam comment.
Why is Bayesianism not as good?
An hour long!?
Hooray!!
the thumbnail is so convincing that I kept ignoring this, thinking it was an ad
same, until I realized I'd said it to myself. On a closer look those parts look dangerous unless used in clock assembly or something similar.
This video should be a must for science educators, professors and students.
dear Rohin, (or Dr. Francis?) it is so nice to hear you speak i such a kind and non-cynical way. don't get me wrong, i appreciate the sharp ultra-intelligent, hard-crust sarcastic innuendos. as an art. and it feels good to be part of a club of the chosen ones who can catch them quickly and also serve them with a straight face to those who have no idea... but it is SO heartwarming to see you well rested and kind and patient actually explaining stuff with compassion. no elites. very unifying and human. i have just rewatched this video after seeing some of your recent ones and the contrast is so big. this is no critique. we just appreciate you and all bright lovely minds and hearts of this world. i guess what i meant to say i hope you are well and have enough time to rest and enjoy life and your loved ones. many many thanks from austria.. (mother of 3, non-native here, also english is not my fist language. so in case i made no sense: we love and appreciate you. hope you are well, fed and [reasonably] happy 😉) 😉❤️🙏🙏🙏
thank you for what you do. you have no idea what it means to so many you will never meet. just helping me keep my sanity during the dark times of covid, masked kids and homeschooling while on zoom business meetings (maybe just escapism, dunno and don't care 😂) made SUCH a difference. and generally: whoever appears on the interwebs speaking kindly, basing assumptions on some facts and keeping the big picture.. just. thank you. humanity has a chance.
From Australia the "black swan" example seems really silly. For us it's white swans that are rare... which probably shows something about selection bias or cultural relativity or something.
I’ve got the same thing with the “when you hear hoofbeats think horses not zebras.
I’m South African, I’m about equally as likely to see a zebra as I am to see a horse 😅
I love your videos, informative . However when you post quotes maybe keep them up on screen for a few seconds longer, depending on word length. I read fast but sometimes can’t read the last few words.
Agree! Im a fast reader, but had to pause for full comprehension and effect.
Modern conventional medicine in the UK normally does the exact of opposite of giving you a nice human interaction, you normally just rudely get told to go away...
This is, as most of your videos are, a very compassionate and humanist view on a subject that is often plagued by elitism
Thank you so much for this.
I've got sucked into the Andrew Huberman podcast vortex and started to seriously consider some life changes based on his claims. Visual flow, sunlight in the morning, etc.
While none of these would be harmful, it just changed my way of thinking about these claims.
An that's why we need you, to shed light and slap us back to reality every once in a while
I don't know why exactly Huberman recommends it but getting some sunlight on your face in the morning is almost certainly good for you. Definitely a mood booster. We're hardwired to respond to sunlight. Our circadian rhythm is powerful, man!
Some people really be like "I won't take a walk until you can show me some RCTs that prove it to be beneficial" lmao.
@@Christopher-md7tf lol, some people I've been in touch with couldn't comprehend the benefits no matter the format or medium. I wish it would be easier...
Playing devil's advocate here, but what you're basically saying is: "this guy says X and I believed him. Now this other guy says X is wrong, and I believe him instead"?
I'm assuming you're a layperson, just like myself, and have no way of verifying either the research cited by Huberman, nor Francis' claims that this research is flawed. So how are people like us supposed to make up our minds? That's the real problem here. Aside from the fact that different experts will interpret the same data differently, which doesn't make it less confusing, folks like us simply don't have the required knowledge to "do our own research". Nor the time, for that matter. We need experts to summarise the research.
And what Huberman contributes in this space that makes his podcast valuable in my opinion, is that he doesn't just point out statistically significant correlations, but distills actionable protocols that are easy to understand. E.g. he doesn't just say "exercise more", he tells you which type of exercise is beneficial for achieving whatever goals you've set, and how much is sufficient to reap the bulk of the benefits before you hit the law of diminishing returns.
@@EvenTheDogAgrees
I don't usually reply to comments or contribute to threads as I believe online commenting and arguing is counter-productive, harmful even.
But you made some good points and touched on a topic I find really interesting, especially with the recent developments in Large Language Models.
Indeed I am a layperson. I agree so much with your statement here and the sentence preceding it:
"Folks like us simply don't have the required knowledge to "do our own research" "
But I would even go further, relying on this quote: "There are no facts, only interpretations." Even if we can interpret the data, that's what it is. It's interpreting it in our own way, instead of digesting the interpretation via Medlife Crisis or Andrew Huberman. I've seen vastly different interpretations of similar or the same studies with varying conclusion.
Also, I'm not disputing that Huberman contributes to the space by condensing research into digestible pieces.
To address your first statement: "this guy says X and I believed him. Now this other guy says X is wrong, and I believe him instead"
In this scenario it's just simply about echo chambers. This channel and the information provided was a valuable voice of reason, a counterbalance to some of the claims made bu Huberman.
If I would seriously consider whom to believe, I would look behind the scenes. Huberman, while receiving income from his academic contributions also benefits hugely by the increased social reach. (content monetized) He hired a team to pre-digest these studies and now, instead of focusing on his field (which I totally believe he is an expert in) covers a wide array of topics. He follows the Joe Rogan, Lex Friedman, etc. podcast bro wave. It's his job and main source of income now. He benefits from more content, more reach and engagement, etc.
So if I'm choosing which "truth" to believe, I'm going with the one that doesn't benefit for more people watching or sharing it. (or at least only partly)
Please don't take it as a personal attack on his character or his work. This is just what I would consider.
I think he indeed adds a great value, but can also get carried over and provide quick decisive conclusions.
All I'm saying by my original comment: It's always nice to hear another perspective, because, at the end, we are easily deceived, even when it's based on scientific research. (which used to be my single root of truth, but turns out studies and interpretations are both flawed - and not created equal.)
When the nurse at the psychiatric hospital I was at was recommending vitamin-D for my depression, I just wanted to scream.
What was worse was after when she ordered bloodtests for my serum vitamin-D level, apart from regular tests; and my results came with high levels of Vit-D, she buried her head in the sand and told me I should take more of it.
To be fair, giving people big pills that do nothing is probably one of the more effective treatments for depression, but only if the patient thinks it helps. I hope you found something that works for you!
@@armadillito Well in terms of medication yes. In terms of treatment 30 minutes physical exercise iirc dwarfs everything else we've tried for most people.
My cat lost a bunch of his teeth due to "tooth resorpotion"...nobody knows what causes it, but one of the leading theories is too much vitimin D in commercial cat food. (There is no upper limit for vitimin D in pet foods.) (Edit: Getting a friendly cat (or dog) is almost certainly a better treatment than vitamins!)
Some people are known to give placebo because they think it would help. Just like some people pray all the time, as if any of those wishes will be answered. If you believe the Vit-D nonsense, the placebo effect might work on you. Even if it does not, taking extra Vit-D does not pose any harm. That is the rationale for some docs. It may not necessarily come from pure incompetence.
@@frankxu4795 a nurse is not a doctor with diagnostic training. And if a blood test comes back reporting high vitamin D levels yet said nurse still recommends taking more vitamin D, that's incompetence.
The segment on Vitamin D reminds me of Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure".
I like your title for the mechanism fallacy. It’s so easy to feel certain about things we already agree with; it’s comforting. Until it fails us.
YESSSSS what a lovely Christmas gift for us!! We love meandering video essays :D!!
Thank you for acknowledging the merits of non-scientific practices. Understanding the limitations of science is fundamental to its application, and accepting the value of untestable beliefs is key to stripping those beliefs of scientific costumes. When an experience can be accepted for its subjective benefits, there’s not need to dress it up with supposed scientific credibility, especially when applied in areas where science is known to be unreliable.
Here from Nebula (they really need a comments section). Vitamin D is a huge deal to my dad who works as a locum GP and those he works/used to work with, he's constantly going on about it. My GP is where my dad used to work (now that he left I can go to the nicer surgery), and so basically all of my requests go via my dad to my GP and it's handled immediately. I needed some bloods taken and needed my GP to sign off on it, he screenshotted their texts to tell me it was done and that I now just needed to book the appointment, but in those text my GP mentioned that the labs are currently declining doing all vitamin D testing (I guess it really is that pointless), and she went on to say that I should just take vitamin D suppliments (I already take multi-vitamins because why not it's cheap and some of the vitamins are essential), they then both spoke about how important it is and how vitamin D deficient everyone is in the UK.
My dad is still holding onto low vitamin D = higher risk of bad covid. He's aware of correlation does not equal causation, he used "quack" the last time we spoke, he's constantly shitting on the latest health thing my mum finds on instagram, and yet still holds onto it as fact.
In every other regard he can show that he's not an idiot, he's an incredibly well loved and caring doctor (at school, I was relatively popular because a lot of people had my dad as their GP and they love him), he never does anything wrong, but he can focus on the wrong things that have no difference.
For me, something doesn't add up about this whole vitamin D debunk.
If vitamin D supplementation doesn't provide health benefits, it must mean one of two things.
One reason could be that there's no such thing as vitamin D deficit, because no matter how low your vitamin D level is, your health outcome is the same. Could that be true? Then why do recommended/normal levels exist? How were they determined?
The second reason would be that vitamin D supplements don't really affect the level of vitamin D in your body. How could that be possible? Either the digestive system is not able to ingest vitamin D from food (we would know that by now, right?), or all the supplements are fake.
Could there be any other explanation for supplementation not working?
Another thing, it seems there's more to vitamin D than "bioplausibility". I'm thinking of the fact that people's color of skin is directly correlated to the geographical latitude of the place their ancestors lived in. Some people even have a special mechanism that makes their skin color change depending on the season. We don't see such correlations and mechanisms in other species close to us. This suggest that it's really important for human body to receive just the right level of sun light - it's significant for our survival. I thought that vitamin D was the explanation for this. If not, we have one more mystery that needs explanation.
Hi fellow Nebula-follower! I agree, the thing I miss most on nebula is being able to greet and thank the producer. Downsides of a comment sections are, of course, moderation requirements. An unfortunate truth of the internet since the 1990s.
@@speedstone4 Hi, I didn't know about some people having a special mechanism that makes their skin colour change depending on the season, I'd like to know more. I'm presume you're not just referring to people getting a tan? Is there a specific source you can recommend?
You raise some interesting points about the biological pathways. One thing I've heard is that Vitamin D3 is more bioavailable than D2, as it is the natural form the body makes - but it doesn't necessarily travel the same route of course. One of the things that led to vitamin D as being suspected as being a factor was that in the UK people with darker skins tended to have worse outcomes from Covid, and who also tend to have lower vitamin D levels, but I knew people with relatives in villages in India and Africa where they were wondering what all the fuss was about and large funerals and weddings were carrying on as normal with no apparent consequences. Also in Israel, they discovered that orthodox Jews with the clothing covering more of them and wide-brimmed hats that keep the sun off their face were also much more susceptible to covid. Of course, we nearly all spend more time out of the sun in the last 100 years than in the previous tens of thousands of years, so the actual sun may very well be a factor.
@@herseem Of course I was referring to tanning. I just wanted to point out that it's not "just" tanning when you think about it, it's quite an impressive development that evolution has come up with, so there must be an important reason for it.
So your suggestion is that the actual sun light is important, but it doesn't explain anything. It's not like white cells need to be directly hit with a sun ray before they start functioning properly, right? There must be some mechanism. If we can figure it out and come up with interventions that can be used when sunlight is not available, that would be very important for a lot of people.
@@speedstone4 I'd like to debunk you on two fronts using a sample size of 1, which is better than none I suppose? One is that there is no such thing as vit d deficiency. There most certainly is, and it is not fun. Two supplements work, because I have actually blood test pre and post supplementation. Now does everyone need it? Not really. But fundamentally it is relatively harmless with a very high toxicity threshold and with significant symptoms caused by deficiency, it makes sense to generally supplement. Now I don't know what to make of it but anecdotally my last major depressive episode was when I was dangerously deficient in vit D.
“Somebody offering you attention, listening, saying something soothing…”
Indeed in psychology and the behavioral health field we call this “the therapist effect” and it’s our interpersonal version of a placebo effect, against which any research evaluation of a specific intervention or psychotherapeutic technique must be compared to claim increased efficacy versus “treatment-as-usual”. Because we know that really does help most people at least a little bit, no matter what else may or may not be going on.
I could have listened to this topic for hours. Please do a deep dive into more.
Often a long wait for your videos, but always worth it.
In the VITAL study, the treatment group was given 2000 UI daily but the placebo group was allowed to take 800 UI, plus most of the participants already had sufficient vitamin D levels to begin with, so it's unclear if this actually *says* (as you state) that vitamin D is just a bystander. The primary endpoint was about cancer, but they only followed up people for 5 years, which is a very short time. There are several limitations in this study, but the fact that it didn't focus on people with vitamin D deficiency is even properly acknowledged in the conclusions of the ancillary study to VITAL that focused on frailty ("Effect of Vitamin D3 and Omega-3 Fatty Acid Supplementation on Risk of Frailty - An Ancillary Study of a Randomized Clinical Trial"): "These results do not support routine use of either vitamin D3 or omega-3 fatty acid supplementation for frailty prevention in generally healthy community-dwelling older adults not selected for vitamin D3 deficiency."
I generally agree that low vitamin D association with many diseases is not a cause but more likely a consequence (if your health is bad, you end up spending little time outdoors, less sun exposure, less vitamin D). But going from that to saying that having low vitamin D levels is not that important (is not really a vitamin!) is really a stretch.
Exactly, surely having a normal level of vitamin D is better than an insufficient level? Does it really matter how you obtain it then?
Love your pivot into being a video essayist! Although you aren't quite up to Hbomberguy length yet, so keep working at it (yes I did watch it all - and I want my get well quick pills dammit!)
“The clothes of science” that sweater looks like it could be on a wax statue dedicated to the House of Tudor
Your videos are simply the best (and most entertaining) presentation of health and medical information and debunking of myth and misinformation currently available. Thank you thank you for your contribution to evidence-based living.
I didn't expect to watch it until the end, but hey, it was just too compelling! You got a like from me today, pls do more of these.
As editor of Infrared Scrotal Studies, color me flabbergasted
Myers Briggs personality test is basically astrology for science majors. Yeah, it is not scientific but it appeals to my love of giving tests and filling surveys.
Spent 2 minutes trying to pause at 02:28 and was not disappointed.
Thanks for the time stamp!
We have hotkeys for that, next time use "," and "."
i've basically got to listen to every one of medlife's videos more than once to glean what i'm meant to be gleaning, but like. gosh am i glad the videos are being made
Best 1hr period
“Eat food. Not too much. Mostly plants.” I haven't read the book by Michael Pollan but this really struck me when i saw it floating on the internet.
When I mentioned this quote on Reddit one person responded with “this is so vague it’s useless.” And it is vague. But it shows that people want a specific solution to health and that doesn’t exist.
@@nekowolf583 that's so interesting! I interpret the "vagueness" as a broadness in which people can find their own specificity. "Food" and "mostly plants" can be a lot of things (although i also interpreted that to mean, the closer to unprocessed the better) but that leaves it up to the eater what kinds of things they like to eat. And "not too much" is also personal. You know when you're full or not!
it's baseless advice though, why eat plants? eliminating plants from my diet improved my health greatly
@@shellderp it's generally good, science based advice for most people. Eliminating most meats from my diet has been great for me 🤷🏾♀️ but if the opposite works for you, more power to you
I'm one of those awful patients who always asks my doctors how the treatment their doing actually works. But now this is making me rethink asking about the mechanisms for things. Though, my main consultants are quite good about citing studies and evidence.
dont be afraid to ask questions of your doctor. if a doctor doesn't want to answer or dismisses you, it's a very bad sign.
There's nothing awful about wanting to understand what's going on with your body, even if it's just for your own peace of mind. I always ask questions because it helps me remember things and motivates me to stick to the treatment plan.
Knowing the mechanisms of action is important - it's just not indispensable to medicine. There is a surprising number of widely-used therapeutic options whose mechanism is unknown. Still, it's a great thing that you're interested in how your treatments work!
If I understand correctly, knowing the mechanism may help you experience the placebo effect, which can improve your health outcomes in addition to the physical effects of the treatment. You can still benefit from asking for an explanation, while keeping in mind that there may be insufficient evidence to support the theory.
The main takeaway from the video shouldn't be to avoid questions on how it works, but instead to *also* ask if it has been shown to work well, regardless of how it works. Knowing both is great, and more beneficial than either one, so you sure can keep asking why :)
Biases? Affecting me? Hogwash. *snorts Paxlovid and prays to Ba'al Hammon*
Welcome back and thank you for the work that went into this.
Wooo you talked about ORBITA!
Thanks for making such a great video. I've needed this exact video on the mechanistic bias for years when speaking to people. Now it'll be so easy to just link to this.
I think you may have missed the point about children masking (it's fine, most people did): they *are* a very low-risk group but many *teachers* are in high-risk groups and they know how often kids get them sick. My mom, who was a teacher at the beginning of the pandemic and is in her 60s, absolutely did not want to return to in-person schooling for the very reason that kids wouldn't be consistent at masking but she sure as hell was going to enforce it as best she could when she didn't have a choice. It wasn't about keeping the kids healthy, it was about keeping herself and her colleagues healthy.
That masking is not about the person wearing the mask is a maddening problem especially in hyper-individualistic American society.
Being in an enclosed room with 25 people all breathing for an extended period of time makes the masks meaningless anyway. They aren't breathing into a filter that is absorbing what they are breathing out. There is just a barrier that stops some of what their breathing from going too far away from them, but that breath is still there in the room and does circulate. The mask only helps for very short term interactions.
Hampering the immuno and social development of children who need facial cues, using masks that are only rated down to 0.1 microns (at best), equals nothing but lost life years for the kids. Loss of educational quality reduces lifespans, and kids have a narrow developmental window to learn facial cues, without which the kids develop anxiety disorders. Take it from someone who found out that the most expensive N95s fail against grain dust (which is mostly finer than coal dust, but far larger than viral aerosols). Even when the masks were taped on to reduce air-gaps, Brownian Motion carried that grain dust right through and turned my snot black within half an hour.
Masking against a virus that spreads primarily through air conditioning? Superstitious nonsense. Watch what actually happens when someone sneezes into a mask, versus when they sneeze into the crook of their elbow. Then look at foggy glasses, or at people walking in the cold like steam trains, and ask “is it really better to shunt our exhalations higher into the air where aerosols linger longer?”
And don’t even get me started on the fancy new graphene masks. Whenever that type of mask is cheaply made, it crumbles inside the fabric, then easily escapes into the air or lungs. Might as well wrap your face in a coal miner’s hankerchief.
@@WisdomThumbs masks don't hamper social or immune development in children. they may be pointless because kids are not consistent, but that doesn't make them harmful
@@platedlizard This is basic pedagogy. Depriving young kids of the ability to see and learn cues outside their immediate family is directly linked to increased rates of emotional and psychological disorders. It's almost as harmful as depriving them of language itself. And for nonverbal kids who are too young for precise fine motor control, *facial cues can be their only method of communication.* Have you ever taught a child with a speech impediment when one or both of you are wearing masks? Try it, you'll catch yourself exaggerating the mouth and tongue movements to *show* the child.
It's even more important for infants and toddlers to see the mouths and faces of adults during social interactions. That's foundational to cognitive development. This process is weak at first due to newborn eyesight, truly begins around month 1, increases around month 3, and by month 6 (once they have a few phonemes down) they watch mouths intently. Their exposure to facial cues remains developmentally critical for 6-7 years. Missed development in childhood leads to issues in adulthood, with one example being increased rates of drug and alcohol dependence. Do you see how that poses problems for kids who are surrounded by mouthless people for 2-3 years?
I'll quote from Child Development
Vol. 60, No. 2 (Apr., 1989), pp. 411, "Children's Integration of Facial and Situational Cues to Emotion" (Hoffner, Badzinski):
"The ability to interpret emotional communications has an important influence on how people perceive and interact with others (Buck, 1984). Children's skill at decoding nonverbal cues affects their ability to empathize with others (Feshback, 1978) and is important for successful interpersonal relationships (Feldman, White, Lobato, 1982.)"
Wow, I did not expect this video to expose one of the biases I myself have been guilty of, since I'm generally decently well educated about scientific methods. Even as I'm typing this comment I'm becoming aware of more topics I may simply be wrong about due to them making sense to me and it's kind of scary. A problem I tend to run into a lot is that the specific things I would like to know about simply have no associated clinical trials (yet), or that those that do exist have major flaws such as very small sample groups etc.
And despite the lack of evidence (in any direction) I still need to make risk assessments etc. or am simply trying to figure out explanations for certain oddities which don't make mechanistic sense.
I think I'll still have to run with "the best explanation I have" even if that's just a mechanistic assumption in cases where no good evidence exists until there is evidence to falsify any of my models which will then force me to improve them.
So, while I don't think it's wrong for me to think the way I do, I certainly have occasionally put too much stock into things which make sense to me.
thank you so much for this amazing video. it’s great you mentioned andrew huberman, even if it was only in passing - i just finished a neuroscience degree and he annoys me to no end. it’s just common sense advice like “sleep and eat well” but cloaked in neurobabble nonsense like “dopamine fasting” as a way to sell it to people who just aren’t that keen on following simple but effective advice.
So you're saying that Andrew is not saying anything incorrect, but it still bothers you?
On the other hand "eat well", "sleep well", "exercise sufficiently", "spend some time outside" are indeed common sense, but also utterly useless on account of being super vague. The added value of Huberman's podcast is that he distills the research (which may or may not be correct; as a layperson I have no way of verifying it) into actionable protocols. Which types of exercise should I do? How much of it? Well, he clearly breaks it down: if you wish to achieve X, focus on exercise of type A; for Y, focus on B. And this is the amount of exercise you need to do to reap the bulk of the benefits; after that, you reach the territory of diminishing returns. Great! That's something I can work with!
That said, he does tend to be pretty long-winded (and trust me, I am aware of the irony, coming from me), repetitive, meandering, and his podcasts have gotten so long that it's impossible to keep up with. I'd have preferred if he'd stuck to his original format of approx. 90 minute episodes, and doing multiple episodes on the same subject to cover all the important aspects. It's not like his is the only podcast worth listening to, and we all got jobs and chores and social obligations.
...and what a great magnum-opus it is. Thank you for the amazing overview, and highlighting how important critical thinking and healthy scrutiny is. I hope you have a great New Year's eve, and all the best for 2023.
Excellently written and presented.
Thank you. This really made me realize some problems with my own thinking and question advice I had previously given to others with, what turns out to be, way too much confidence.
All while believing myself to be smart and well-informed. It's really easy to overestimate yourself
Sometimes I think learned people are easier to fool partly because we spend between four and eight(!) years going to school and learning things that are correct and yet counterintuitive. So we start to think that if something is counterintuitive, it must be correct. However, if it smells like bullsh*t, it's usually best to assume it's bullsh*t until rigorously proven otherwise. I'm reminded of a comment attributed to Carl Sagan: "Yes, they laughed at Einstein. But they also laughed at Bozo the Clown."
Thanks for prompting me to finally get the treadmill I've had in my Amazon cart for a few days. The cr*p weather part of the year is coming up, and I have zero intention of slipping on ice and breaking a leg in the service of good health, so I finally figured I should just buy one of the stupid things.
Just wanted to say that the thumbnail for this video is 10/10 A+ premium certified.
It's not the point of this video, but mechanistic research is still an essential part of medicine. If we only conducted randomized controlled trials, you wouldn't come up with the drugs to test in those trials. It's not possible to test every molecule in randomized controlled trials as that would be both unethical and unfeasible both logistically and financially. Mechanistic research provides rationale to design those trials. I think this is important to remember.
Yes - as I said in the video, it's very important as the starting point of research, but people mistake it for the final step
People like stories, mechanistic explanations make for good story telling.
Weird, this didn't show up in my recommendations. Thanks for the video!
Awesome video, which really got me thinking about my own biases and how I look at my own health or experiences within my own body. I think, as a layman, I often go that "mechanical" route of explanation. However, as soon as I read an actual medical paper I go: "huh, it's much more nuanced/complicated than that." I also started paying more attention to papers that admitted they didn't have all the answers, but more like in a "that's super confusing and weird but we don't know why because we actually don't know that bodily process that well" way. I feel like some researches really need a working explanation but I guess a lot of research is just trial-and-error? (I don't know, I am not a scientist lol)
I was also wondering as you explained how vitamin d is a bystander/marker for other things and you mentioned the extra heartbeats, which you said are extremely common, what are they a bystander/marker for? Would love an explanation for this! Thank you!
Some bystanders are like looky-loos at an accident scene....not there for any particular reason, but sometimes they get to be in the news photos.... ;)