Why Do People Keep Falling For Things That Don't Work?

There’s one particular mental trap that seems to fool everyone, especially those WITH medical knowledge.

Writing: Rohin Francis
Editing: Tanmay Nandanikar and Rohin Francis
Thumbnail design: Simon Buckmaster

0:00 Intro
3:41 The demarcation problem
6:44 Pseudoscience
9:06 Homeopathy and chiropractic
11:20 It's nice to feel nice
13:37 Bioplausibility
16:39 The mechanistic bias
17:06 Hard vs soft; clean vs messy science
20:25 Mechanistic examples: COVID Rx and masks
24:40 Diets
28:12 Vitamin D supplements
36:36 The Big Pharma graveyard
45:33 Most therapies don't work
47:07 Influencers' love of sexy mechanisms
50:25 Closing summary

References:

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More Medlife Crisis:

[MedlifeCrisis]

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

[urbanhribar]

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.

[WelfareChrist]

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.

[bdarci]

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.

[nameisblank]

"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

[TommoCarroll]

That thumbnail is disgustingly good. Well done sir 👏

[mudshovel]

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.

[rabbitrockbush]

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

[LinusBoman]

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!

[Isparavanjeloollollololl]

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.

[mangosteen]

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.

[LlamasOnJUPITER]

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

[NielMalan]

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."

[stephaniehyatt]

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.

[unlearningeconomics]

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.)

[Vade_mecum_]

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."

[drakemarsaly]

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

[StrongMed]

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.

[kioarthurdane]

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.

[rumidude]

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.