Technology will put an end to witch hunts

We must challenge experts claiming to act on evidence they don’t share. It's time to take The Sniff Test.

The Boundaries of Belief

Easter Island is remote. Its inhabitants are more than 2,000 kilometres from the nearest people. The island is home to over 1,000 stone statues erected by a population that all but died out.

Their story is told as an environmental cautionary tale. The inhabitants cut down the trees to move ever bigger monuments to their ancestors. Without the tree roots, the soil slid into the ocean and the islanders starved. The lesson is not to mess with nature.

There is an alternative version. As food ran short and people starved, the elders insisted that larger monuments were required to appease the gods. Only doubling down on what didn’t work would save society. No one dared to suggest leaving the trees.

By Eric Gaba (Sting), translated by Bamse via Wikipedia

A closed society is one in which social status comes through conformity. This often leads ambitious people to become more zealous and to punish those who even think to question. The inability to embrace new thinking leads closed societies to fail.

Easter Islanders today are reliant on the outside world and survive because of progress in transport, refrigeration, communication and all other aspects of modernity. Humans overcome obstacles by pushing the boundaries of belief.

A Grand Theory of Government

Ten days ago, the BBC aired a Panorama episode about menopause care in the UK. The villain was Newson Health, a private clinic that goes beyond the guidelines of the medical establishment when treating women who don’t get the support they need from the NHS.

The show starts with a dismissive review of supplements marketed to relieve menopausal symptoms. The carefully chosen selection don’t do anything. This has nothing to do with Newson Health, but is a cheap trick to associate snake oil salesmen with the company.

The trick is to introduce the idea of evidence-based medicine. This phrase litters the website of the British Menopause Society, a charity that is the guardian of the guidelines. The suggestion is always that the evidence supports the authority, although the Easter Island example shows that in a closed society this is not the case.

Evidence-based was a popular marketing phrase a decade ago. The start-up I worked with toyed with the term evidence-based finance, but lost interest because all quantitative work analyses data. You can’t run an algorithm without evidence and what matters is the interpretation. Evidence-based finance is like a restaurant serving a food-based menu.

There are marketing alternatives to evidence-based. Proven is less clumsy and means more. So why doesn’t the BMS provide proven science?

Elite authorities govern through the control of information. Only the high priests of Easter Island could communicate with the ancestors. The people just had to chop down the trees and starve.

Digitisation of information and its free distribution on the internet undermines authority. Anyone can now find and create information. This divides opinion and makes it harder for authorities to control the narrative.

Politicians talk about the public as a whole. They are on the side of hard-working people who are the silent majority. But the public is a mass of different opinions. It unites in opposition to ideas, but not to create alternatives.

This is the logic behind my grand theory of government. You see what I did there? I labelled my thoughts as a grand theory. As I observe politicians, I could just as easily claim an evidence-based theory of government. My theory is that government can prevent harm but is unable to do good.

The journalists at Panorama understand their power is to create villains not promote heroes.

The Use of Public Money

There is a hierarchy in any elite and those at the top control the pace of change. This must take place at regulation speed and through official channels. If you want to go faster then be prepared to fight. When you belong to a group, it is particularly painful for its guns to be trained on you.

Why do elites resist change? Controlling information is access to wealth and power. When you question the facts you are a direct threat to that wealth and power. How do you expect elites to respond?

Last week we met Brian Leiter, a member of the elite who argues that untruths are acceptable to maintain social cohesion. There is time for errors to be corrected but this is only possible if people remain passive. Trust the process, trust the elites, because the alternative is chaos.

By definition innovators are odd. By odd, I mean different, which is a good thing. If you are a cheerleader for the opinions of the elite, you are not going to change anything. Only those who would stand out can do that.

We filter information through our preferences, experiences and social pressures. This is why people interpret the same evidence in different ways. Media manipulation is about applying peer pressure, often in a witch hunt.

Witch hunts are as old as society. They persecute those who are different. You might not consider yourself different, but you don’t decide. If you question the authority of elites, then you will be subject to a witch hunt.

Okay, so witch hunts aren’t new and neither are proceedings against rogue doctors. Why does this exposé standout and why care about Newson Health? Two reasons, one personal and one about The Sniff Test theme of the end of the age of experts.

Dr. Louise Newson and family are my friends. She faces investigations by the General Medical Council and the Care Quality Commission. These are regulators not charities, with senior appointments controlled by politicians. They have a process to follow, but someone also saw need for a witch hunt.

I’m no expert on the menopause but I see evidence of its effects. I know it’s a worrying time for many women and how hard it is to get NHS care. An effective health service provides base levels of care supplemented by the private sector.

I do know statistics and have a tolerance for bad writing that allows me to read research papers. Given how evidence-based the BMS is, I expected to read the evidence on its site. Instead there are two books to buy and the Post Reproductive Health Journal. This is the BMS’ own journal and is not free to the public.

I did discover that recommended doses of Hormone Replacement Therapy are guidelines. I was unable to trace the research behind them, but it may exist. Panorama kept repeating that there is no evidence for the doses that Newson Health sometimes recommends. The implication is that they are unsafe, but I can’t find the evidence either way.

Perhaps fresh research would be a better use of public money than a witch hunt.

No More Statues

This paper is by specialists from the Mayo Clinic and Harvard Medical School and reviewed by European researchers. It is a study of studies. The original scare that HRT causes breast cancer and cardiovascular disease came from a 2002 paper. The effect was only on women over 60 who were more than 10 years on from menopause. 18 years of follow-up research shows women are no more likely to die on HRT than a placebo, and that certain younger women are less likely.

The BMS site repeats that women must be treated individually almost as much as it claims to be evidence-based. I agree, as too much of what passes as medical advice is based on averages. As a man I need 2,500 calories a day, should have no more than 14 units of alcohol a week, and have a BMI of less than 25. Imagine if I could only buy clothes for someone 5 foot 10.

Newson Health provides additional treatment for women who still suffer on the guideline dose. These are women seeking help. Among the tens of thousands who are helped, there will be a few that are not suited for higher doses. Interviewing them on television proves nothing.

I’ll say this because Newson Health never could. There must be personal responsibility when you ask for help. The company website is clear that it does not believe one size fits all. But personal responsibility undermines our system of experts. Why?

Experts require dumb people.

Technology is changing everything. I can have a DNA test and analyse my genes, and an algorithm will provide me more personalised advice than my doctor. The bureaucrats cannot keep pace with what’s happening.

What’s more I can go online and use AI to research a topic by asking simple questions. “Where is the evidence for that?” is a good one. Everyone can be informed, which is why the experts are afraid.

Louise Newson won’t be the last doctor to be tried in public. But the era is ending in which experts hide behind evidence that they don’t share. AI means fewer dumb people willing to go along with experts advising us to build another statue.