Doctors and Science

Lately, I have been thinking about doctors, because I have recently been so dependent on their advice. My dentist, my eye doctor, and my chiropractor have all offered me expert opinions on my body and what I ought to do about it. Even though I am still quite healthy, doctors are much more important to me now than they were 20 years ago. For my parents’ generation, doctors become best friends, visited nearly every week, keeping people alive.

Doctors are scientists of the body, trained in the best science, expected to know the newest developments in their fields. Because they are scientists, they are both theoreticians and practitioners. When they talk with me, I hear them placing the knowledge they receive from others alongside years of experience. They adjust techniques and try out new medicines. I especially like when they explain to me how they came to their particular recommendations, which may be different from what I heard from other doctors in the past or what they themselves used to recommend. They rarely say that a particular outcome will inevitably follow a particular course of action. There are always uncertainties.

In the end, the most important decisions are always mine: do I get this operation? which medicine do I take? when do I go back for another visit? I know that their words are the most important factor, but I also recognize my responsibility and the range of choice I have.

We all make medical choices which reflect some influence of the scientific advice we get. When I needed a tooth capped, I had to choose between using gold or using porcelain. That wasn’t too difficult, especially since my dentist, Bill Weller, said that, in his experience, gold was better suited for that purpose over the long term. When my foggy lens with a cataract was replaced, I had to choose between a standard artificial lens or a newly developed and much more expensive lens that could act like a bifocal.

Choices about our daily routines, which should also be influenced by doctors’ expert opinions, often are not. For a long time, I have had cholesterol levels that are regarded by doctors as too high, and I have changed my diet, but I refuse to give up cheeses. My eye surgeon just recommended that I take two pills daily to reduce the risk of future degeneration in my eye. But I am reluctant to accept a daily regimen of pills that will continue for the rest of my life. The older people in my family use a daily tray of pills, and I am trying to delay the onset of daily pill-popping as long as possible. I recognize this is an emotional, rather than a rational response, but that doesn’t make it any less powerful for me.

Where my non-rational impulses and preferences conflict with scientific opinion, that’s exactly where I am less likely to follow expert advice. That is especially true when the science involves a healthy mixture of opinion, when a lower level of certainty allows me the wiggle-room to insert myself into the decision. If my doctor told me that I would definitely die 2 years earlier if I didn’t give up the cheese, I’m sure my generous consumption of cheddar, Parmesan, blue, Swiss, and all the other delicious inventions of dairy farmers (you can see how hard this is for me) would decline significantly.

In my opinion that is the central problem with the public acceptance of global warming. Little about global warming is certain, except that it has been occurring for a century and that doing anything about it will be very expensive. Its causes, future effects, and thus the actions we should take, are all properly expressed with probability and uncertainty. Thus other elements of our thinking intrude more insistently: political preferences, attitudes toward government programs, and beliefs about the “free market”.

We are more susceptible to lone but loud voices which happen to match our emotional preferences, to non-experts who say the experts are all wrong. We are less likely to see self-interest, including our own, in seemingly reasonable arguments. We are more easily convinced that “wait-and-see” is the best choice.

All of these responses are fundamentally different from the way we treat the scientific opinions of our doctors. Their science is no less tinged with uncertainty and probability. The difference is that they are talking about our health, today or tomorrow. And as we get older and more mature, we are more likely to take their advice. When it comes to global warming, thus far the public is like a teenager who hears that tanning booths will produce skin cancer much later in life: I’ll worry about that later.

Our planet is sick now. If we wait too long, the disease may be incurable.

Steve Hochstadt

Jacksonville IL

Published in the Jacksonville Journal-Courier, June 7, 2011