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The Expert’s Expert Finally Provides the Unequivocal Definition You’ve Been Waiting For
“All Theories are wrong, but some are useful… How wrong do they have to be to not be useful?” ~George EP Box~
This quote from George E. P. Box (footnote #1) above is itself wrong, but perhaps not wrong enough to not be very useful. Box’s quote brings to mind the opening lines of the Tao Te Ching (footnote #2) (Lao-tzu), which begins the 81 verse text with a disclaimer that all intellectual theories, especially grand concepts aspiring to explain “everything,” are wrong… “The tao that can be told is not the eternal Tao. The name that can be named is not the eternal Name.” I imagine from reflecting on George Box’s photo and from what little I know of his work, that he must have an awesome sense of humor.
I often invoke such quotes when I am asked to comment on various, treatments, philosophies, theories and approaches to healthcare. Now that I am branded as an “expert,” somehow others believe that I have an angle on certain truths and insights. Boy, are they in for a shock! The epitome of a true-blue American, a dandy Yankee-doodle-dandy (footnote #3), I have always mistrusted authority, institutional and governmental authoritarianism and anyone putting on an air of sophistication. While sticking “feathers in your cap”, may appear charismatic and somehow seem attractive to most folks, I prefer the Zen position that such people “stink of ego.” This theory is wrong too, but I have found it to be useful.
Any intellectual position automatically defines an opposite position. Any exposition of any theory or position will invite the naysayer’s retort. Assert that “Up” is true, and sure enough, someone will come along and suggest that “Down” is true too. Irrefutable Truth can’t be expressed without opening a space for the contradictory position and therefore all theories are ineffable (footnote #4). However, life demands that we take positions, “because unless we stand for something, we shall fall for anything (footnote #5),” which is of course yet another wrong but possibly useful position.
This is not to suggest that the Truth can’t be known; only that it is inexpressible. Perhaps creative genius, expressed through certain mediums such as art, music, sculpture, dance, acting, poetry and literature, comes closest to expressing ineffability, like the Sistine Chapel ceiling fresco, painted by Michelangelo in the 16th century, depicting God’s hand nearly touching that of Adam’s. Consider another wrong, but possibly useful theory, that Truth is definitely knowable and in the eyes of the beholder, but it is simultaneously ineffable and can never be completely expressed in its entirety.
In every election cycle, we witness two or more polarized positions which are not only wrong, but I believe are mostly not even useful, unless you happen to be a politician, or media consultant seeking to capitalize on wealth and power through dissension and class warfare by aligning yourself with one extremist position or another. Since only about 50% of Americans vote, perhaps we could postulate two extremist groups which are equally represented in the electorate.
The voters, proponents of blind faith, make up of the true believers of any party or group. They hold to the notion that the Truth is both knowable and expressible in speech, writings (e.g., the Koran, the Bible, the Communist Manifesto, the US Constitution) and in the ballot box by the voters. At the other extreme are the non-voters, those who carry the mantle of nihilism, meaninglessness, anarchism and agnosticism, professing that The Truth is both unknowable and ineffable.
This second position was expressed by Freddy Mercury (footnote #6) and the rock group Queen in the Bohemian Rhapsody in the lyrics “Nothing really matters.”(footnote #7) That is, if nothing matters except possibly having my hedonistic desires for money, control, sex, drugs and rock n’ roll met, then why vote? I find this theory to not be useful and even lethal – it was expressed by every one of the many dozens of my patients over 35 years who have committed suicide.
Extremist positions are seductively well-defined and having in my life experimented with both the positions of nihilism and blind faith, I can understand why unambiguous, black and white, rigid thinking engenders a certain security and is found to be attractive by many people. However, inflexible extremism has also been proven to emanate from neurologically damaged brains, and not wanting to go gaga in my golden years, I have found a compromising position, that the Truth is both knowable and ineffable, to be the most useful and to be the least wrong.
What Healthcare Treatments Are Truly Proven or Unproven?
On the Planet where we live, the only bodies of information I have ever found to be “proven” are certain systems of mathematical logic, such as the square of the hypotenuse of a right triangle is equal to the sum of the squares of the other 2 sides. Aside from this, I have never encountered anything to be proven, especially in healthcare. Should you encounter a claim that such and such a treatment has been “proven” to work, you have my expressed permission to smash a pie in the claimant’s face.
In healthcare, claims of proof are advanced for three reasons, which happen to be the three underlying motives (the 3Ps) fundamentally driving all healthcare; Power (e.g., governmental regulations), Profits (e.g., drug companies) and Prestige (e.g., healthcare providers). Nothing is proven in medicine, except that there is a lot of power, profits and prestige to go around. Another wrong but possibly useful theory.
Considering the useful George Box quote above, that “All Theories are wrong, but some are useful… How wrong do they have to be to not be useful?”… I could propose another wrong theory that could nevertheless be very useful. Although nothing is proven and all theories are wrong anyway, some approaches in medicine are so wrong and unproven that they are not useful. Others are relatively not as wrong and they are more proven than others, and therefore they are useful. Where you draw the line here is in the eyes of the beholder, but if you seek advice of an expert, I recommend putting them through a “trial by fire” – they should agree with three issues below.
1) For a medical expert’s opinion to be considered useful, they must have a healthy disrespect for authority, which in healthcare is driven by the 3Ps, power, profits and prestige, and they must not be ensnared in the 3Ps themselves. This is easy to figure out, just follow the money. Who do they work for or represent? Are they being paid by their patients, or are they being paid by the government, drug companies or organizations which represent healthcare professionals? (footnote #8)
2) Any expert, before providing a useful opinion, must agree with George Box, that all theories (even theirs) or information they provide you with is wrong and will ultimately be “proven” to be very wrong as science marches on, but the utility of the current information may make it worth communicating anyway.
3) For an expert’s opinion to be considered useful, they must understand the ineffability of expressing truthful information, so that, while they may know the truth about what you need to hear, they also know they will never be able to express it with anything close to perfect clarity (unless perhaps they convey it as a professional, jazz saxophonist or as a world-renowned poet!).(footnote #9)
I hope that that this information, which is totally true, does not hinder you in seeking from me, the expert’s expert, the “proven” “truth” about healthcare issues. Having come through the trial by fire (3 questions above) with flying colors, I might come just about as close to being useful to you as any healthcare expert could be, that is unless you ask me about something that I know nothing about, at which point I will arrogantly dismiss it as meaningless.
“If a doctor is not up on something they will be down on it,” quipped one of the greatest scientists of the 20th century, Linus Pauling.(footnote #10) So before you seek my advice, do some checking ahead of time to be sure that its something I have at least heard about. Otherwise, like most physicians who believe in their omniscience, not only do I know-it-all, but my vast mind only concerns itself with useful information only, and anything I don’t know about is therefore irrelevant, and I will be compelled to dismiss your question as baseless and “unproven.”
Hm…, on second thought, that’s one position I never found to be particularly useful.
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Footnotes
1) Box served as President of the American Statistical Association in 1978 and of the Institute of Mathematical Statistics in 1979. He received the Shewhart Medal from the American Society for Quality Control in 1968, the Wilks Memorial Award from the American Statistical Association in 1972, the R. A. Fisher Lectureship in 1974, and the Guy Medal in Gold from the Royal Statistical Society in 1993. Box was elected a member of the American Academy of Arts and Sciences in 1974 and a Fellow of the Royal Society in 1979.
2) Tao Te Ching (Last updated 20 July 1995), written by Lao-tzu, from a translation by S. Mitchell.
3) As a term Doodle first appeared in the early seventeenth century and is thought to derive from the Low German dudel or dödel, meaning “fool” or “simpleton”. The Macaroni wig was an extreme fashion in the 1770s and became contemporary slang for foppishness. The implication of the verse was therefore probably that the Yankees were so unsophisticated that they thought simply sticking a feather in a cap would make them the height of fashion.
4) in•ef•fa•ble adj \(ˌ)i-ˈne-fə-bəl\ 1a : incapable of being expressed in words : indescribable
5) Peter Marshall (1902–67) Senate chaplain, prayer offered at the opening of the session, April 18, 1947. Prayers Offered by the Chaplain, the Rev. Peter Marshall … 1947–1948, p. 20 (1949). Senate Doc. 80–170.
6) The lyrics “Nothing really matters – nothing really matters to me.” By Queen, Bohemian Rhapsody, written and sung by Freddie Mercury. Released 31st October, 1975.
7) The lyrics “Nothing really matters – nothing really matters to me.” By Queen, Bohemian Rhapsody, written and sung by Freddie Mercury. Released 31st October, 1975.
8 ) I have found without exception that physician’s are not greedy or interested in power, but are truly dedicated to the well-being of their patients. I defend them when they are falsely accused of being motivated by the first two Ps, power and profits. Doctor’s are motivated primarily by prestige, believing that the approval of their peers and the world in general defines their self-worth. Therefore they form all kinds of “clubs” and organizations to applaud each other’s efforts and provide certifications and board approvals to assure their credibility.
9) I don’t know many healthcare peers in these categories.
10) Linus Carl Pauling (February 28, 1901 – August 19, 1994 was an American chemist, biochemist, peace activist, author, and educator. He was one of the most influential chemists in history and ranks among the most important scientists of the 20th century. Pauling was among the first scientists to work in the fields of quantum chemistry and molecular biology. Pauling is one of only four individuals to have won more than one Nobel Prize and is one of only two people awarded Nobel Prizes in different fields (the chemistry and peace prizes), the other being Marie Curie (the Chemistry and Physics prizes), and the only person awarded two unshared prizes.
Above article by Integrative and Functional Medicine Doctor: C.E. Gant, MD, PhD.
{ 1 comment… read it below or add one }
That was great. Well written.