Friday, August 26, 2011

The Role of Anecdotal Information in a Modern Health Care System

Some argue only scientifically proven methods should be used for treating patients. FDA style double blind studies to prove efficacy before patients get the treatment. Therefore anecdotes such as a patient saying some weird unstudied thing that helped them should be discarded as useless information - unscientific.
But where do ideas for new treatment studies start?
Weird anecodotal stories.
For example I was reading some comment forum on a documentary about autism. The vaccine anecdotes came up - a few parents saying soon after vaccination there was a fever, then they noticed the symptoms of autism appearing. It's easy for a health professional to discount this as parents looking very hard for someone to sue to recover the horrible costs and burdens of caring for an autistic child deep into adulthood. Lets call that the law-suit hypothesis. One parent said her son was sick a few years later with a fever, and behaviour returned to near normal, briefly. Now that's a weird annecdote, and doesn't seem to be tied to the law suit hypothesis.
If I'm a university researcher looking for something to research, I might pick away at that annecdote, by forming hypotheses:
H0: lawsuit hypothesis
H1: parent imagining things
H2: real symptom mitigation but unrelated to fever
H3: real symptom mitigation and related to fever:
H3a) something about the metabolism of the brain being reset lower during a (ie vaccine induced) fever during a critical brain growth period, and another fever brings the brain metabolism back to normal
To test H3a I might run a properly controlled studied (double blind, placebo control group) where I give some medication that increases metabolism of internal organs including the brain -I think thyroid hormone will do that- and if that makes a difference then I'll do more studies to try and isolate brain metabolism

A treatment may or may not result. The point is the annecdotes are very useful starting points for investigation. That's how a lot of discoveries are made in many fields. An accidental weird data or annecdote, further investigation and bingo. And annecdotes can come from outside of the research community. Inbreeding of ideas within a scientific discipline can result in stagnation, and annecdotes from non-scientific sources are a great way to open up new investigations.

Annecdote -> hypotheses formation -> scientific research -> dead end / new insight / treatment

But if I'm a researcher, or a health practitioner, or a health insurer or health system developer is there a way to systematically gather and mine annecdotes, since they can be so valuable? I think that's the next step in the evolution of modern health care systems.

Thursday, August 18, 2011

Good and Bad Peaceful Protesting

Stanley cup and London riots recently have put the spotlight on social dynamics of protesting, and in particular, what happens when a peaceful protest turns ugly.
In many democratic countries, we have a right to peacefully protest. Lets say I excercise my democratic right to peaceful protest, and plaquard in hand, I join the street crowd to march in protest. So far I'm a good Peaceful Protestor.
Now lets say the guy beside me pulls a scarf over his face, flips a hood over his head, pulls out a brick, and throws it through a window. He's a Violent Protestor. I'm still a Peaceful Protestor. But here's an opportunity to be a good or bad peaceful protestor. If I'm a Bad Peaceful Protestor, I'll watch the guy, cheer him on, and let him duck behind me away from surveillance cameras. If I'm a Good Peaceful Protestor, I'll quickly put several dozen paces between me and the Violent Protestor, exposing him to police and surveillance cameras, and giving riot police a clear shot at corralling/teargassing/rubber-bulleting just the Violent Protestors.
Should there be a law against Bad Peaceful Protesting? What if I don't see the Violent Protestor throw the brick or mask his face? It might be too much to make that a criminal offence, and probably the average Peaceful Protestor isn't analyzing the situation in detail, so wouldn't have read up on the fine print of Peaceful Protesting. So more people would be charged, but with little change to the tenor of protests.
Tactically and practically though, if I want to avoid teargas, batons and rubber bullets, the several dozen paces rule of thumb seems like common sense. So police should be ready with teargas and let it fly when the window breaks. A right to peaceful protest and a right to be teargassed for sheltering a violent protestor should go together as twin rights.