Comment by Dove

> What happened is that during my literature review, I disturbingly realized that what I had been told at the hospital ... was an assertion based on very weak scientific foundations. And yet ... has been taught as though it was a proven fact to generations of physicians all over the world.

This exact thing has happened to me so many times, on so many different medical topics, that it is now my going in assumption that if I review the literature, this is what I'll find. The most flabberghasting case was one in which I was able to determine the standard of care the doctors insisted on was in flat contradiction to the established science in the course of an afternoon. As a mathematician by training, I am used to checking the reasoning behind everything I believe for myself. I can understand not having taken months and months to delve into a deeply technical topic, but when the state of affairs can be determined in an afternoon? I cannot fathom spending a career giving people advice and never having looked that far.

My favorite example of obvious, silly unscientific behavior is the basic set of practices and beliefs surrounding blood pressure. Blood pressure varies a lot, second to second, minute to minute, hour to hour, and day to day, with an astonishing range, for a very long list of reasons both benign and concerning. It is an obvious fact, well known and easy to establish by anyone with a measuring device and a little statistical curiosity. The literature, the instruction books shipped with measuring devices, the procedures followed by doctors and nurses, the procedures they say they should be following, bear all the hallmarks of the behavior of the statistically unsophisticated seeking patterns and meaning in randomness. But my very favorite behavior is the sheer cognitive dissonance. I have had nurses take my blood pressure while varying the circumstance - sitting, lying, this arm, that arm - until they got the answer they wanted, reported it to a doctor, who compared it to a chart with great authority and made a claim about my health over a span of months and years. I have had a five minute conversation with a doctor about the statistical variation of the number and the fact that best practices involve taking many measurements and he opined that it wasn't really valid unless you measured it over twenty four hours... and then said, "anyway..." and proceeded in the next sentence to diagnose me and argue strenuously for a prescription based on a single measurement and no context.

One of the things I find cynically, darkly entertaining is how often the standard advice is, not just random, not just useless, but exactly wrong. The diet they insist on to manage gallstones is known to cause gallstones. The treatment traditionally insisted on for diabetes is known to kill you faster the more exactly you comply. The saline typically used in hospitals, compared to an electrolyte balanced solution, is known to kill patients. They institutionally get saline wrong!

The absolute theatrics and bureaucracy required historically to institute handwashing in hospitals indicates a cultural problem, and the current state of affairs suggests to me that it remains. I am not talking about advancing scientific knowledge here - I am talking about accounting for things that are well known and can be checked with little effort so long as one is not intimidated by basic science. The prospect of professional mathematicians behaving this way is laughable. Everyone knows the discredited results and no one would dream of using them. The prospect of cybersecurity professionals taking years to apply a patch after a security flaw is discovered beggars belief. Yet here are the doctors, insisting with great pomp and authority on easily checkable wrong things, and they have apparently been doing so in many domains, for a very long time. I know there is value in medical advice, and in many situations I seek it, but it is enough to make one want to throw in the towel and consult the aromatherapists and their healing crystals - at least they won't insist on something destructive!

The words "scientific medicine" clearly do not mean what I would think they should mean.