A dive in plausibility preceded by three insights
All four motivated by a Critical Care Medicine issue
I.
I DON’T usually read the Critical Care Medicine journal. I think I earned the right to ignore it after so many years. I used to be fascinated by American journals. Now, I think they are precisely what blocks our specialty from developing. The journal perpetuates serious mistakes in biological plausibility assessment. The problem with intellectual colonization is that American mistakes are exported worldwide.
I usually eyeball through the CCM journal TOC almost unconsciously, without noticing anything. This time, I stopped and read because I saw a name: Dr. Andre Kalil. He comments on a notable study about nosocomial pneumonia. Excellent, as usual. However, I couldn’t avoid going through the rest of the issue.
Oh, man. How lost we are. CCM is home to science-free critical care, the dog-level reasoning I named Dogtensivism. American influence spread Dogtensivism around the globe.
II.
Sometimes, at night, when the Genie keeps me awake with irreconcilable thoughts about my dear specialty and its dire predicaments, I hear their bark.
They bark loudly in North America, others respond in Europe, and I can listen here. I also listen to the local Dogtensivists emulating American Dogtensivists’ theory-free science mimic.
They keep barking, maybe to the moon, as if barking could move the moon and announce a new day for critical care. It won’t. Science doesn’t walk because you bark at it. Science needs scientists, not barking dogs.
If you haven’t met Luke, the inductivist dog, the intellectual mentor of critical care pundits, please click below (link in caption).
III.
Inductivists believe that universal laws can be derived, but not refuted, from particular observations. The classical example is the refuted universal conjecture “all swans are white”, popularized by Taleb following Popper’s illustration. Taleb has improved it in his funny turkey parable. I will try to reproduce it by memory. A turkey lived on a farm and sent weekly reports on human behavior to a turkey organization. He (I always assumed it was a he) was convinced of human generosity, for the farmers gave daily proofs of generosity towards the turkeys.
Like the Dogtensivists, our poor turkey assumed a conjecture can't be refuted, only improved by additional observations. I imagine how detailed and reassuring his reports were, describing all the nuances of loving human care. He presumably reported empirical associations between the many variables at hand and devised different phenotypes of human interaction.
One day, of course, the whole theory was tragically refuted.
Like Taleb's turkey or my dog Luke, critical care pundits are inductivists.
This is what the whole “precision critical care” trend is about. Never thinking seriously about biological plausibility, they try to derive general conjectures from empirical observations. When facing an unexpected observation, they add accessory conjectures instead of refuting the main idea and moving ahead.
They do it because they can’t grasp biological plausibility.
Come on over. There’s hope. Let's talk about biological plausibility, blindness to marginal utility, and its consequences.
IV.
Paid content
Dogtensivist’s ridiculous claims illustrated by CCM's recent papers on fluids and fatty acids in sepsis.
Reasoning about causal reasoning.
Biological plausibility must account for marginality.
The Additive Paradigm.
Dominance.
Disease model as a scientific conjecture.
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