Contemplating life.

Approaching the shrine of evidence

or: I’ve come a fair distance, but have a long way to go.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.

I recently embarked on postgraduate studies. My thirst for knowledge needed quenching, and my post-graduation emptiness needed filling; I was bored and suffering intellectual directionless. These issues have been rectified with a quite interesting Postgraduate Certificate in EMS leadership and Management.

But back to topic: I remember my first dabbles amongst paramedics…the spoken word of these people surrounding me was at first unintelligible blabber of latin and greek derived technical teminology, but with time and a dictionary, I cut through most of that. I had a basic understanding, and I was proud of myself.

Then came basic skills and principles of paramedicine: I was told about these many things that paramedics do, and I took them in as “that’s what paramedics do”. The occasional question was usually answered with some scientific based background knowledge that I did not possess, but sounded more than plausible.

In my mind, I could picture the shrine of evidence.

Then I got a copy of some clinical guidelines. Thoughts similar to “They must be right, the big people on the ambulance follow them, and I’m sure a lot of time and effort went in to writing them” went through my head.

From a distance, I could see the shrine of evidence.

Then I started studying paramedicine. I entered the beautiful world of evidence based practice. “It’s in a scientific journal, it must be right! They’re scientists after all!”. And along came large Randomized Control Trials. “The peak of trials! Truth! TRUTH!”

The shrine of evidence began to glisten. Polished marbled with golden words in capital letters sparkled from it. a truly majestic and intimidating sight. Upon it written in bold letter:

“Science is evidence is truth.”

Still not completely confident with the world though, more background knowledge on this whole topic was needed, and which is why I did not adopt the above statement.

I want to get closer to the shrine, but my sunglasses aren’t dark enough to ward off the sparkling and shining.

Then my lecturer recommended to read this.

Clouds pull up. The shrine has some ugly cracks in the foundation, and…wow, part of it is built on rotten wooden stilts!

A great read from “The New Yorker” Magazine, by Jonah Lehrer (December 13, 2010).

Read, ponder, and rethink your worlds. After all, we’re all only human.

Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.


We’re not nearly so clever as we think. We don’t know nearly as much about the human body, how it works, how it breaks, or how to fix it as we delude ourselves.
All science should be taken with some skepticism and with the knowledge that at some point what we know for certain today will be unmasked as ignorance in the future.

As a doctor and blogger I know says, “Half of everything I learned in medical school is wrong. We just don’t know which half.”

Apologies if I mangled her quote, but you get the point.

Very little I was taught in medic school 22 years ago is still current. We don’t use MAST trousers, fluid boluses, Bicarb, defibrillation for Asystole, or any of the other skills that were state of the art back then.

Who back then would have thought that we’d do compressions first, defibrillation second, and that Atropine would be out of the protocols?

I imagine that this trend will continue long after I’m retired from active service.

Time marches on.

Rogue Medic says:


Jonah Lehrer did respond to some of the criticism of his post-modernist statement that we need to choose what to believe.

Science has errors because science is a work of people, who are not perfect, and because of reversion of extremes to the mean. This is quite different from the claimed decline effect. Science does correct for its errors.

For example, Leher clearly states the following –

Question #1: Does this mean I don’t have to believe in climate change?

Me: I’m afraid not. One of the sad ironies of scientific denialism is that we tend to be skeptical of precisely the wrong kind of scientific claims. In poll after poll, Americans have dismissed two of the most robust and widely tested theories of modern science: evolution by natural selection and climate change. These are theories that have been verified in thousands of different ways by thousands of different scientists working in many different fields.

So much for having to choose what to believe.

This does not appeal to some of the anti-science fan boys who flock to articles that appear to provide evidence that science is wrong.

We need to better understand science to not be misled by poorly done research. We have been too satisfied with surrogate endpoint studies, but these should be the bases of hypotheses of well controlled, randomized, double-blinded outcomes studies.

We have been foolish to be satisfied with poorly controlled, very biased research. To blame the method, rather than those misapplying the method, is a mistake.

Also read these rebuttals –

Is the “decline effect” really so mysterious?


Is the “decline effect” really so mysterious? (revisited)


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