Cracked Backs & Mosquito Attacks: How Even Docs Can Be Quacks

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Cracked Backs & Mosquito Attacks: How Even Docs Can Be Quacks 
By Heath Shive

Causation confusion – or causefusion for short – is any misunderstanding about the causes of complex events. 

No one wants to feel ignorant.  Ignorance insults our vanity.  And the unknown can be frightening.  So we oversimply – for various reasons – so at least we can pretend to understand. 

Causefusion is a cognition trap, one of many explored by Zachary Shore in his book “Blunder: Why Smart People Make Bad Decisions.”

To the science!

Malaria: It Was Never “Bad Air”

The Romans believed that swamp air caused illness and disease.  They called this sickness malaria, from the words for bad (“mal”) and air (“aria”).  So the Romans drained the swamps.  The disease incidence dropped dramatically. 

So bad air caused the disease.

Except it didn’t.

Now science connects malaria to blood parasites transmitted by anopheles mosquitoes.

For centuries, medical authorities thought that draining swamps destroyed the disease, even when those efforts failed. 

Malaria outbreaks were decimated only with the introduction of mosquito-busting measures, like mosquito netting, citronella plants, using insecticidal surfactants (like DDT) timed to mosquito breeding cycles, and eliminating any mosquito breeding grounds (not just swamps).

Back Pain: Not in Herniated Disks

For years – and to this day – many blame their back pain on herniated disks in their spine.  The doctors saw your herniated disks with an MRI.  Nodding their heads, they would point out your herniated disks and insist you needed surgery. 

Surgery is an invasive and expensive procedure.  Yet many back surgeries fail to provide pain relief. 

So what if herniated disks were never the problem?

In 1994, a study in The New England Journal of Medicine pointed out the non-sequitur. 

People without back pain (asymptomatic) were examined with a MRI.  Of the 98 subjects (mean age, 42 years), 52 percent had a bulge on at least one disk, 27 percent had a protrusion, and 1 percent had an extrusion.  Also, 38 percent had an abnormality on more than one disk!

Yet none of these people had back pain!

Back pain wasn’t simply about herniated disks or even spinal abnormalities. 

So the benefits of some surgeries are questionable at best.  Medicare has been debating their protocols and now sees some surgeries (like spinal fusion) as a waste.

The Burden of a Complex World

When the Romans drained those swamps, malarial incidence decreased.  But without the mosquito part of the equation, malaria couldn’t be combated effectively.

Some treatments for herniated disks seem to bring significant pain relief.  But obviously, herniated disks alone are not the problem.

We want understanding.  Simplification seems to offer that understanding.  But simplification can also create – what Shore called –“monocausal myopia.”  That’s the trap – the cognition trap – that Shore warns us about.

We make assumptions, we limit our thinking.  And that limit puts the brakes on our progress. 

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Sources:

Jensen, Maureen C, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross.  Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain.  New England Journal of Medicine 1994; 331: 69-73 (July 14, 1994). 
Shore, Zachary.  Blunder: Why Smart People Make Bad Decisions.  Bloomsbury, 2008.

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