Saturday, June 07, 2008

Without logic we are truly lost...

When I train developers, I like to point out that they (we) are very special people: we use symbolic logic day in and day out to do our jobs. Why does that make us special? Logic forms the foundation not only of software programming, but more generally of "civilization" as we know it. Cell phones, the Internet, cars, medicines -- anything manufactured -- all follow from two wonderful developments in our evolution: an opposable thumb and logic.

Logic is also tightly linked to critical thinking: it is hard to tell when somebody is pulling the wool over your eyes, when you cannot logically identify flaws in their arguments. When, however, your brain is well-trained to move from assumptions to conclusions via clearly defined rules of logic, it is much easier to (a) solve problems, (b) challenge bogus arguments, and (c) avoid voting against your own self-interest.

I ran across a great example of such manipulation through explicit violation of logical thinking in the latest issue of Discover magazine. The title of the article is "Medicine's Magic Bullets?" and it is another in a seemingly endless stream of seriously bad news regarding the way that pharmaceutical companies lie and manipulate "research" data to get FDA approval for their drugs. Before I get to the part about logic, here's one quote to give you a feel for what I am talking about:

"One reason many doctors overlook risks and believe statins to be safe is that most controlled studies of stains wind up excluding people who originally began to participate in a study but stop taking the drug because they experience problems with it; these test participants are then dropped from the study as 'non-compliant.'"

Please do stop for a moment and think about that.

OK, now on to my main point regarding logic: this article talks about how pharmaceutical companies can camouflage unfavorable results through "combination end points."

Hmmm. "Combination end point" - what might that be? Well, a drug can be tested for multiple outcomes, such as heart failure and blood pressure. That surely sounds reasonable.

But then we learn that:

"By combining two or more of these outcomes to create a single category, you can say it helped 'A and B' even if it only helped A and not B. For example, although there was no statistically significant effect from tPA in the NINDS trial on the number of patients who died, there was a small decrease in disability for those who survived. With those two factors combined, there was technically a decrease in the combination end point of 'death and disability.'"

I would like to think that at this point, the mouth of any and every software developer reading the above paragraph will be hanging open in disbelief.

For those who might still have their mouth closed, allow me to explain:

When you say "A AND B", that is only true if both A is true and B is true. If either are false, then "A and B" is also false. If, on the other hand, you assert "A OR B", then only one of the two need to be true to render the whole statement true.

So when the author writes "you can say it helped" and "technically a decrease", I have to ask myself: precisely who can say that the statement "A AND B" is true even if B is false? And what technology is being referred to there? The technology of anti-logic?

I am shocked first of all that Discover's author would not explicitly point out the fundamental logical flaw of this "combination end point" bullshit.

And I am afraid, very afraid, for a nation in which...

* a critical regulatory agency like the FDA can accept such blatantly false thinking as a path to approving drugs which can and do kill people on a regular basis.

* citizens can read such things and not realize that they are being treated with disdain, are beging manipulated and, ultimately, put at risk of illness and death in order to improve the profit margins of corporations like Genentech (the maker of tPA, which is the main subject of the Discover article).


Chris said...

I would say that the AND in "death and disability" is not a logical AND, but the word used to signify a set theoretic addition (i.e. a logical OR) in everyday speech. When the captain of the Titanic says "Women and Children first" he means anyone who is a woman OR anyone who is a child. Wasn't the point of the paragraph to show that this sort of language is very slippery? Or am I being overly generous?

Steven Feuerstein said...

Yes, Chris, I think you are being very generous, indeed! I suppose it is possible that Merck and Abbott Labs and Genentech and others have on-staff logicians to help them clarify their usages of such terms in combination end points.

But that sounds a bit far-fetched.

Michael said...

Notice how your friend Chris was willing to jump on the logic band wagon that was given; although he picked an interesting route to go. I am assuming that Chris, like others in the programming industry, has a background in understanding logical constructs. He brings up the exact point that the manufactures were hoping someone would see and therefore validate their argument. Most people do not understand logic or set theory and when given an argument that sounds valid are willing to believe it. This is how our society has ended up in such bad shape. People have enough on their plates and are usually very knowledgeable about what they do; ie a plumber knows about pipes, a programmer knows logic, a day care person knows child behavior, etc. A person wants to believe that our experts won’t lie and will provide information, like clef notes, about a subject matter so that us none experts can make an informed choice. Unfortunately, greed says lets blur these lines so money can be made. Instead of being clear, one is obscure so that the obvious choice is favorable on the side you want and not necessarily the side of truth. The only way to stop this is for more people to question these so called experts instead of being spoon fed. I laugh every time I see a commercial about a new drug because the side effects alone are enough for me not to want to take it. I believe what we need to do as a society is to re-organize the FDA. They have been so lax in inspecting our food and our drugs that we should fire them all, rewrite what exactly it is society wants them to do and rehire new people to implement the plan? Thanks for another interesting blog article.


Girl Next Door (gnd) said...

Like Michael pointed out, when we are really in need of medical advice we should be able to trust these so-called experts! Wish it were that simple! My daughter has a skin condition for which her dermatologist recommended Protopic and Elidel. He said he was in the meeting that made these two creams infamous. The studies, according to him are based on results from using them on monkeys (which have a completely different skin structure than humans and a different life-span), so he suggested that they are completely skewed and that we should not worry about the hype. He however, was unable to guarantee that my daughter (who was just about 4 at the time) would not end up having cancer because of the prolonged use! Of course not! What was I thinking even asking him that?
Ended up switching to an alternative therapy and been with it since!