People used to frown at shouting matches in parliament. Then they began to laugh. Shouting matches are funny, if you ignore manners.
The Jerry Springer Show (1991-2018) won fame for a new kind of nonsense. Guests would shout and attack each other — rip off clothes, punch, cry.
Spectacle became education.
Never knowing true debate, viewers learned that shouting is debate. Many doctors learned the same lesson.
Medicine Needs Debate
You make a statement. I counter with logic and facts. You respond to correct my content with better content.
You do not yell halfway through my counter.
Shouting, crying, or silent protest are appeals to emotion and guarantee failure.
But the age of debate is gone. That of emotion, outrage, and lobbyists has succeeded; and the glory of medicine is extinguished forever. (paraphrase)
The End of Medicine
Senior medical delegates now prefer emotion over logic. They bluster and deplatform those they do not like. They attack, block, and some even sue their colleagues for saying things that offend them. If it offends, it is evil and must be eliminated.
This marks the fall of an institution.
Institutions are like families with unwritten norms and behaviours. Mom lights the candles. Birthday girl cuts the cake. It matters not if Dad lights and Mom cuts. What matters are intangible patterns which form the fabric of the family. Eliminate the fabric and you eliminate the family.
Happy families are all alike; every unhappy family is unhappy in its own way.
Medicine cannot function without unspoken agreement on how to engage. We used to seek out strange ideas for no other reason than to prove ours are still sound.
COVID-zero organizers gained attention in 2020: “One case is too many!” Skeptics were dismissed as COVID deniers.
Leaders qualified the hysteria insisting that, of course, they never meant zero as a numerical outcome. Zero is an aspirational goal, a target.
Media loves COVID-zero. Radicals make great slogans.
Uneducated Experts?
Barbarians were ignorant of Greek culture: art, history, philosophy, and so on. But they were expert at being barbarians.
Doctors train to be experts in a thin slice of knowledge. Universities offer English-for-science-students courses.
Doctors do not need history or philosophy. They can skip the western cannon and get on with STEM. Students load up on STEM courses even in high school; ignore everything else.
Scientific Success
Science requires a social fabric. That fabric used to exist in all the courses science students skipped (in so far as the courses still exist at all, which is a separate blog).
For example, science uses ancient Greek and Roman values: honesty, courage, prudence, and self-control, as well as honour, magnanimity, decorum, and so on.
Science students must tell the truth, follow evidence wherever it leads, avoid emotional whim, and much more.
Absent these values, science fails.
Science also needs basic logic, for example, the law of identity. A rose is a rose is a rose. A rose cannot be a petunia, while being a rose.
And yet modern people insist that individuals must be allowed to be a rose in a petunia patch.
They demand a spot on the football team, while refusing to tackle or throw. They fight to be players, who cannot play but still win scholarships.
And we must celebrate their new kind of justice.
There used to be no stupid questions. What is the number needed to treat? Are there long-term studies? What is the side-effect profile?
Now, some questions are not just stupid; they are dangerous.
If treatment lands on the list of socially righteous services, then you had better show support. Do not ask if medicare should pay for it. That would be offensive. Show your support and sound like you mean it.
Can We Save Medicine?
We cannot shout at the shouters. Shouters ignore logic. If you stoop to their level, they will beat you with experience.
Art once maintained civilization. Even popular buffoonery, such as Monty Python, entertained by poking holes in hypocrisy. Today, comedy struggles. Audiences must recognize nonsense in order to laugh. Laughing at what you hate is just scoffing, not humour.
Social interaction used to maintain civilization too. COVID emptied public spaces. American outrage porn emptied virtual spaces. Canadian media picked up the trend to avoid losing viewers.
People now huddle in private groups on new platforms, where they can share without fear. Doctors once used Latin, in part, to defend against mobs who disapproved of things doctors must discuss.
Fight or Flight?
The end of debate marks the end of medicine, as we have known it. Medicine cannot exist without evidence, logic, and dispassionate debate. We can only save it by supporting each other when someone is brave enough to ask a question.
Without true debate, medicine becomes a technological service, without nuance or reflection.
We must fight the mobs or hide out from them in new enclaves of sanity. Will we have the courage to save medicine once more?
When I am weaker than you, I ask you for freedom because that is according to your principles; when I am stronger than you, I take away your freedom because that is according to my principles.
– Frank Herbert, Children of Dune
PS. Thanks to all of you for checking out my new book! When Politics Comes Before Patients continues to do well and has bounced in and out of bestseller status for the last 6 weeks … more in than out 🙂
“Shouting” is so passé…it’s now the woke cancel culture with its intersectionality and ideological spinning …deaf to debate.
Good point, Andris. Cancel spreads faster than shouting for sure. Maybe there are fewer people around to shout at?
Great to hear from you.
I recall a professor 35 years told me the first to yell/curse has the weakest argument. Seems it still applies.
Brilliant. And those were the days when you could provoke someone enough to curse! Now, you must time how long you maintain eye contact — it might be deemed offensive. 🙂
Great to hear from you! I hope you are well
Cheers
Fantastic Shawn!!
“Barbarians were ignorant of Greek culture: art, history, philosophy, and so on.
But they were expert at being barbarians.”
Brilliant!
We are transitioning rapidly.
Many fully embrace the transition to barbarianism…
Some sadly observe and quietly grieve the era of civil debate.
Will medicine survive?
Thank you for your writing.
It’s on point and inspiring.
Thank you, Paul!
I’m glad you agree that we seem to be in transition. Barbarianism feels so good … until it spends all its inherited social capital.
Sure appreciate you taking time to read and post a comment. It inspires me to keep putting thoughts to the page.
Hope you are well,
Cheers
Great piece Shawn.
I would agree with Andris that cancel culture is the biggest threat to medicine today. Medicine is shades of grey, and the shade often depends on discourse among colleagues, which is polarizing particularly on controversial topics, much like in society.The gov’t (read ‘public health experts’ which they say they defer to)response in the pandemic and conversations around that response is a good example.Advocates for reducing the unintended consequences caused by lockdowns/restrictions on our youth/future to effectively prolong the lives of some octa/nonagenerians have been pilloried/cancelled.When you’re a hammer, you see a lot of nails, and it has been hard listening to our ‘celebrity’ infectious disease specialists and ‘epidemiologists'(curious how many are now using this designation)talk about waves,VOC’s,’ public health measures’,modelling, and LOCKDOWNS as if they’re treating a gram neg infection.Get on board …. or get out of the way, and shut up.
I’ve taken to Twitter as the modern ‘public square ‘ to engage in debate, recognizing the square is filled with cutouts/recordings rather than people.
Good to have you writing and blogging.
Solid comments, Ram, as always.
I was happy to see you taking to Twitter. Your courage would work well in that (too often) snake pit of discontent. I have taken long breaks from it, and now tend to avoid offering too many personal opinions. The swarming and vitriol is not worth it. (I just followed you 🙂 )
Thanks for taking time to read, post, and offer encouragement. It’s easy to wonder whether one’s words are hitting anything.
Talk soon
A very well-written article but I’d tend to disagree with its core premise. I believe neither logical discourse, nor spirited debate are dead. What I have observed over my 32 years of medical practice is a strong coercive force for what I like to call the “false consensus”. Debate is often prematurely concluded or intimidation/subtle coercion replaces a sound discussion of the critical issues. The defenders of a healthy, spirited dialogue either retreat into silence or are drowned out by the power brokers who value their authority and its imposition more than the truth. The debate outcome is based on the weighting of “valued” opinions in an exercise of ego rather than founded on sound judgement and principles of deductive reasoning or logic.
Thanks Paul,
You make a great point. In fact, I started this whole blog based on the tagline: “challenging accepted thinking, offering solutions.” So, I offer a hearty two cheers for the false consensus.
I hold back one cheer, because it seems there are now some topics too fearful to question. Whereas a false consensus once forced through its own agenda by crushing competing opinion, the new false consensus exists by forcing dissent underground.
In the end, we might be talking about two different iterations of the same basic phenomenon. I find the modern iteration more difficult to debate, because it rejects reason.
Hey, thanks so much for taking time to read and post a comment! I love it when readers push back and offer a different angle. Brilliant.
Be well,
Thank you, Dr. Whatley, for your excellent article. Sadly, this phenomenon is not restricted to just medicine. For it has spread to almost every profession and has made the task of coming up with rational public policy next to impossible. The reality is that there is no settled science and no one has a monopoly on the truth. Which makes it imperative that we be able to discuss openly and without fear of retribution issues of importance. Sadly, we now have a situation that is strangely reminiscent of the Lysenko affair where politics dictated what passed for science.
Paul!
Thanks so much for adding this. Great points. Your reminder about Lysenko is perfect.
I suppose we cannot blame people for abandoning any attempt at reason or knowledge after spending college learning that knowledge is just power and oppression by a ruling class. The rational response to this indoctrination is to abandon reason and embrace feeling. Unfortunately, happy feelings are not the ones embraced.
Sure appreciate you taking time to read and post!
Be well
Shawn