Michael Vassar: The Current State of Medical Research is Unacceptable

The Co-founder and Chief Science Officer of MetaMed Research dissects the many faults of modern medicine and explains the impetus for founding his own company that offers personalized medical research.

Michael Vassar:  Studies show that the average doctor’s visit involves eight to 11 minutes of doctor-patient time. Meanwhile that medical intake interviews that doctors are taught to give in medical school should take an average of two to three hours. This is pretty typical of the system. Systematically, people are taught to do something in medical school that centuries of scholarly and scientific discovery have shown should allow them to bring humanities knowledge to bear on a case. And systematically, industrial processes are set up to go through the motions of doing something symbolic of that, but which there is no reason to think will actually work.

We have essentially banned the sort of research which has given us all of our successes in medicine from the entire history of medicine. Like, there have been a few kind of decent cancer successes, but there has never been a penicillin; there has never been a smallpox vaccine. There has never been a vitamin C for scurvy. If you look at the sort of research that to which we attribute practically all of the historical successes of science and especially of medicine, we see that there is virtually no funding for it and there is virtually no regulatory framework for doing it legally and for publishing it. The sort of research that we have invented in the post-World War II era is a sort of research that is designed to confirm and assert that we are doing research rather than designed to cure diseases. After we do the research, no one reads it anyway and it’s well known that even if there was no fraud, given the standards that we’re doing somewhere around, as John Ioannidis published in the most-cited paper in the history of PLOS — our Public Library of Science — something like 80 percent of all medical findings, 90 percent of cancer findings, 50 percent of the best medical findings considered highest-quality and 25 percent of medical consensus would be false in the absence of any fraud based on the methodologies.

And that’s not false in the sense of useless; that’s false in the sense of not true. In addition, there’s the uselessness of statistical rather than practical significance, et cetera. Then there is the, as I say, phenomena that generally no one reads the literature anyway because as bad as the literature is, it’s still possible by digging through it in excruciating depth and actually thinking hard in an analytic way doing detective work with the weak clues that it provides, it’s possible to do enormously better than you could realistically expect to do. We have television shows about medical detectives. Dr. House who was inspired by Sherlock Holmes. But have you heard of the CSI effect? CSI is a television show about forensic detectives and the CSI effect is the policy of excluding people who watch CSI from juries because people who have a reasonable model of what forensic science is capable of, but don’t realize that in realistic practice in the ordinary execution of the law this is never done will frequently acquit based on the absence of evidence at a standard that would be considered adequate on television.

And the thing is you could say, "Oh silly, gullible public who expects things to be done right like they are on television," or you could say, "Silly, corrupt system that expects people to consider it legitimate," even though everyone can be shown on television what the legitimate scientific evidence based version of the system would look like. We have the same with Dr. House. What we have in the real world is not, for the most part, in non-dramatized ordinary cases, we do not have detectives investigating crimes in an analytical, scientific, evidence-based exploratory manner. We have police executing police procedures. And that works reasonably well for maintaining public order. But it’s not a plausibly good way of digging into mysteries of any sort. Likewise the hospitals we have execute procedures which prevent doctors from actually having freedom to think and figure things out. Doctors have sort of legal rights to do so, but they’re basically afraid to do so because the insurance companies and professional opinion and the legal system all make it dangerous to do so at all frequently. And so what we have is highly trained people who spend many years learning how to think in order to heal people.

Then being put in a system that is a glorified factory where they’re not actually allowed to think and figure out how to heal people, but instead are supposed to execute procedures that may or may not work, but which are statistically, if executed correctly and no one’s checking to see if they’re executed correctly, pretty well known to, assuming the literature is true, be on average beneficial. So that does have some benefit for public health, but it’s not really very well optimized for public health either because if it was they would be using checklists and expert systems and other techniques which have been known for 40 years or more to be capable of saving 98 to 225,000 lives a year in the U.S. alone as Peter Pronovost has written up extensively about and as Atul Gawande has presented in his book The Checklist Manifesto. If you would like actual medical detective work, you can’t buy it from the local hospital and you can’t buy it from the Mayo Clinic. But you can, if you wanted, to hire a team of doctors with what seemed to you like relevant expertise and a team of scientists to do consulting work; work with them; go to medical libraries; read the papers; and do it yourself.

Most people don’t really have the expertise to do that and either to hire the doctors and scientists or to do it themselves and the price would seem prohibitive to most people. And so I’ve built a system that can do it for you and the price is not prohibitive. It’s actually comparable to all sorts of luxuries that middle-class people have all the time like an extra bedroom or an extra car. But it’s also not cheap. It’s, you know, you’re paying for serious intellectual work. It costs similar amounts to what it would cost to pay for a good law firm to investigate your case if you were in serious legal trouble, which is something that middle-class people would not blink before doing. Because people are not in the habit of seeing medical services as something that they need to provide for themselves because they’re in the habit of seeing it as an entitlement or right, they do the equivalent of going to a public defender almost all the time. So MetaMed has decided to focus more on orphan diseases where the awareness is higher — that the services are inadequate because the medical system in orphan diseases is basically just telling the patients, "No, we’re not going to try to help you," rather than telling people falsely that it’s going to try to help them like it does with cancer or heart disease or neurological disorders or whatever.



Directed/Produced by Jonathan Fowler, Elizabeth Rodd, and Dillon Fitton


 

 

Michael Vassar is co-founder and chief science officer of MetaMed Research, a medical consulting firm that conducts personalized medical research for clients. In this video interview, Vassar explains why the impetus for founding the company and dissects the many faults of modern medical research. Most notably, Vassar decries the fact that we have "essentially banned the sort of research which has given us all of our successes in medicine from the entire history of medicine." Hospitals are factories, says Vassar, in which thinkers are instructed not to think, but to execute protocol. And that's the opposite of progress. You can't make important medical discoveries when you're just pushing buttons.

Politics & Current Affairs

Political division is nothing new. Throughout American history there have been numerous flare ups in which the political arena was more than just tense but incideniary. In a letter addressed to William Hamilton in 1800, Thomas Jefferson once lamented about how an emotional fervor had swept over the populace in regards to a certain political issue at the time. It disturbed him greatly to see how these political issues seemed to seep into every area of life and even affect people's interpersonal relationships. At one point in the letter he states:

"I never considered a difference of opinion in politics, in religion, in philosophy, as cause for withdrawing from a friend."

Today, we Americans find ourselves in a similar situation, with our political environment even more splintered due to a number of factors. The advent of mass digital media, siloed identity-driven political groups, and a societal lack of understanding of basic discursive fundamentals all contribute to the problem.

Civil discourse has fallen to an all time low.

The question that the American populace needs to ask itself now is: how do we fix it?


Discursive fundamentals need to be taught to preserve free expression

In a 2017 Free Speech and Tolerance Survey by Cato, it was found that 71% of Americans believe that political correctness had silenced important discussions necessary to our society. Many have pointed to draconian university policies regarding political correctness as a contributing factor to this phenomenon.

It's a great irony that, colleges, once true bastions of free-speech, counterculture and progressiveness, have now devolved into reactionary tribal politics.

Many years ago, one could count on the fact that universities would be the first places where you could espouse and debate any controversial idea without consequence. The decline of staple subjects that deal with the wisdom of the ancients, historical reference points, and civic discourse could be to blame for this exaggerated partisanship boiling on campuses.

Young people seeking an education are given a disservice when fed biased ideology, even if such ideology is presented with the best of intentions. Politics are but one small sliver for society and the human condition at large. Universities would do well to instead teach the principles of healthy discourse and engagement across the ideological spectrum.

The fundamentals of logic, debate and the rich artistic heritage of western civilization need to be the central focus of an education. They help to create a well-rounded citizen that can deal with controversial political issues.

It has been found that in the abstract, college students generally support and endorse the first amendment, but there's a catch when it comes to actually practicing it. This was explored in a Gallup survey titled: Free Expression on Campus: What college students think about First amendment issues.

In their findings the authors state:

"The vast majority say free speech is important to democracy and favor an open learning environment that promotes the airing of a wide variety of ideas. However, the actions of some students in recent years — from milder actions such as claiming to be threatened by messages written in chalk promoting Trump's candidacy to the most extreme acts of engaging in violence
to stop attempted speeches — raise issues of just how committed college students are to
upholding First Amendment ideals.


Most college students do not condone more aggressive actions to squelch speech, like
violence and shouting down speakers, although there are some who do. However, students
do support many policies or actions that place limits on speech, including free speech zones,
speech codes and campus prohibitions on hate speech, suggesting that their commitment
to free speech has limits. As one example, barely a majority think handing out literature on
controversial issues is "always acceptable."

With this in mind, the problems seen on college campuses are also being seen on a whole through other pockets of society and regular everyday civic discourse. Look no further than the dreaded and cliche prospect of political discussion at Thanksgiving dinner.

Talking politics at Thanksgiving dinner

As a result of this increased tribalization of views, it's becoming increasingly more difficult to engage in polite conversation with people possessing opposing viewpoints. The authors of a recent Hidden Tribes study broke down the political "tribes" in which many find themselves in:

  • Progressive Activists: younger, highly engaged, secular, cosmopolitan, angry.
  • Traditional Liberals: older, retired, open to compromise, rational, cautious.
  • Passive Liberals: unhappy, insecure, distrustful, disillusioned.
  • Politically Disengaged: young, low income, distrustful, detached, patriotic, conspiratorial
  • Moderates: engaged, civic-minded, middle-of-the-road, pessimistic, Protestant.
  • Traditional Conservatives: religious, middle class, patriotic, moralistic.
  • Devoted Conservatives: white, retired, highly engaged, uncompromising,
    Patriotic.

Understanding these different viewpoints and the hidden tribes we may belong to will be essential in having conversations with those we disagree with. This might just come to a head when it's Thanksgiving and you have a mix of many different personalities, ages, and viewpoints.

It's interesting to note the authors found that:

"Tribe membership shows strong reliability in predicting views across different political topics."

You'll find that depending on what group you identify with, that nearly 100 percent of the time you'll believe in the same way the rest of your group constituents do.

Here are some statistics on differing viewpoints according to political party:

  • 51% of staunch liberals say it's "morally acceptable" to punch Nazis.
  • 53% of Republicans favor stripping U.S. citizenship from people who burn the American flag.
  • 51% of Democrats support a law that requires Americans use transgender people's preferred gender pronouns.
  • 65% of Republicans say NFL players should be fired if they refuse to stand for the anthem.
  • 58% of Democrats say employers should punish employees for offensive Facebook posts.
  • 47% of Republicans favor bans on building new mosques.

Understanding the fact that tribal membership indicates what you believe, can help you return to the fundamentals for proper political engagement

Here are some guidelines for civic discourse that might come in handy:

  • Avoid logical fallacies. Essentially at the core, a logical fallacy is anything that detracts from the debate and seeks to attack the person rather than the idea and stray from the topic at hand.
  • Practice inclusion and listen to who you're speaking to.
  • Have the idea that there is nothing out of bounds for inquiry or conversation once you get down to an even stronger or new perspective of whatever you were discussing.
  • Keep in mind the maxim of : Do not listen with the intent to reply. But with the intent to understand.
  • We're not trying to proselytize nor shout others down with our rhetoric, but come to understand one another again.
  • If we're tied too closely to some in-group we no longer become an individual but a clone of someone else's ideology.

Civic discourse in the divisive age

Debate and civic discourse is inherently messy. Add into the mix an ignorance of history, rabid politicization and debased political discourse, you can see that it will be very difficult in mending this discursive staple of a functional civilization.

There is still hope that this great divide can be mended, because it has to be. The Hidden Tribes authors at one point state:

"In the era of social media and partisan news outlets, America's differences have become
dangerously tribal, fueled by a culture of outrage and taking offense. For the combatants,
the other side can no longer be tolerated, and no price is too high to defeat them.
These tensions are poisoning personal relationships, consuming our politics and
putting our democracy in peril.


Once a country has become tribalized, debates about contested issues from
immigration and trade to economic management, climate change and national security,
become shaped by larger tribal identities. Policy debate gives way to tribal conflicts.
Polarization and tribalism are self-reinforcing and will likely continue to accelerate.
The work of rebuilding our fragmented society needs to start now. It extends from
re-connecting people across the lines of division in local communities all the way to
building a renewed sense of national identity: a bigger story of us."

We need to start teaching people how to approach subjects from less of an emotional or baseless educational bias or identity, especially in the event that the subject matter could be construed to be controversial or uncomfortable.

This will be the beginning of a new era of understanding, inclusion and the defeat of regressive philosophies that threaten the core of our nation and civilization.

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