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1) The editorial discusses how anecdotal evidence and exceptions to the norm fueled confusion and debate during the COVID-19 pandemic about treatments like hydroxychloroquine. 2) Medical professionals are trained to critically evaluate evidence and base practice on probabilities, not exceptions, due to human physiology's complexity. 3) Anecdotism threatens the integrity of medical institutions by emphasizing exceptions over scientific consensus. The editorial urges upholding high research standards to counter anecdotism during the pandemic.

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36 views2 pages

Artigo

1) The editorial discusses how anecdotal evidence and exceptions to the norm fueled confusion and debate during the COVID-19 pandemic about treatments like hydroxychloroquine. 2) Medical professionals are trained to critically evaluate evidence and base practice on probabilities, not exceptions, due to human physiology's complexity. 3) Anecdotism threatens the integrity of medical institutions by emphasizing exceptions over scientific consensus. The editorial urges upholding high research standards to counter anecdotism during the pandemic.

Uploaded by

mirellapfb
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Editorial

Scientific Evidence, Medical Practice, and the


Insidious Danger of Anecdotal Reports

Downloaded from https://academic.oup.com/labmed/article/51/6/555/5937037 by Malardalen University user on 29 August 2023


Laboratory Medicine 2020;51:555-556

DOI: 10.1093/labmed/lmaa093

The debate that erupted this year on social media and takes into account other factors, too, such as cost, overall
other platforms about the efficacy of various drugs, most likelihood of successful treatment, potential adverse effects,
notably hydroxychloroquine, for the prevention or treatment to name just a few. But the prudent approach to treatment
of COVID-19 disease illustrated an important difference of illness is to begin with the treatment that is most likely to
between how medical professionals and the lay public inter- be effective, and save anecdotal “cures” for patients who
pret the medical literature. The difference, I believe, is due do not respond to conventional therapy. This algorithm is
to something I will call “anecdotism,” which I define as “the so firmly and logically ingrained into medical practice, that it
propensity to believe in the exception rather than the rule.” seems silly to have to defend it.

In medicine we are exposed to anecdotal evidence so Social media promotes anecdotism by emphasizing the
frequently that we subconsciously develop a filter for it. exception rather than the rule. Anecdotes reinforce theories
Medicine is full of exceptions that violate the norm. The vast that the public is being deceived. If government officials in
majority of patients suffering a myocardial infarction experi- the CDC, FDA, or NIH say a treatment doesn’t work, and
ence chest pain or discomfort, but a few may experience a report emerges describing a case where it appeared to
no discomfort at all. Breast cancer occurs almost exclu- be effective, or a doctor claims to have used the treatment
sively in women, but occasionally affects men. Malignant successfully, then trust in the very institutions supported
melanoma is an extremely aggressive cancer, but there are by tax dollars to give us the best medical information is
reports of spontaneous regression of the disease that defy shaken. Scrutiny often reveals the reasons why these ex-
any medical explanation. Hypertension usually can be con- ceptions exist. The physician or scientist reporting it may
trolled with medication, but a small subset of patients have have an undisclosed financial conflict of interest, or simply
refractory hypertension that does not respond to any treat- desires publicity. The patients may have been selected in a
ment. Prostate cancer is strongly associated with advancing way that biases the study in favor of success. Frequently, a
age, but sometimes occurs in young men. Fetuses with an placebo effect is prominent because no attempt has been
XY genotype almost always develop into males, and those made to avoid it in the study design. The report may not
with the XX genotype typically develop into females, but the have been peer reviewed prior to publication. For medical
opposite phenotype is possible at birth when various rare professionals, all of these factors are taken into account
genetic mutations disrupt normal sexual differentiation. The when evaluating the integrity of information that appears in
list goes on and on. the medical literature. It is a tedious and time-consuming
process, but few survive in academic medicine without be-
Medical practitioners view exceptions to the norm as coming proficient at critically interpreting information, and it
interesting examples from which we might learn something is the process by which the science of medicine advances.
new about the disease process and how it interacts with
human physiology and metabolism. However, doctors do Anecdotism is the antithesis of medical science. Other
not ordinarily change their practice based on an exception. branches of science are much more vulnerable to anecdotal
Physicians base their practice on probabilities: they pre- evidence. In physics, for example, a single observation of
scribe the drug that is most likely to be effective; they make an object exceeding the speed of light will dissolve much
the diagnosis that is most probable based on their physical of the foundation of Einstein’s theories of relativity (and
examination and other data; they choose a therapeutic op- yes, I am aware of “spooky action at a distance”). A single
tion based on its probability of curing, or at least halting the exception can disprove a mathematical theory. Theories of
progression of, the disease. Of course, the actual calculus chemical properties often are proved false or inadequate

© American Society for Clinical Pathology 2020. All rights reserved. For permissions, please e-mail: [email protected] 555
Editorial

by the demonstration of an exception. But that is not the As medical professionals, we inevitably are drawn into
case in medicine. The complexity of human physiology and these debates, and I think we all share a frustration with
metabolism virtually guarantees that exceptions will always anecdotism. Those who practice anecdotism may feel
exist. Rarely does an exception change the overall ap- empowered by their knowledge of what they believe to be
proach to diagnosis and treatment of disease. More often, facts, but they lack the experience necessary to objectively

Downloaded from https://academic.oup.com/labmed/article/51/6/555/5937037 by Malardalen University user on 29 August 2023


it is the other way around, when the accumulation of data assess the veracity of the information they wield, or to put it
confirming the efficacy of a certain treatment makes it the into proper perspective within the larger body of knowledge
rule, rather than the exception. on the subject. In his 2017 book, “The Death of Expertise:
The Campaign Against Established Knowledge and Why It
The combination of fatigue over the pandemic, political Matters,” Tom Nichols examines the reasons why the line
division, and seemingly inexhaustible sources of misin- between fact and opinion has become so blurred in the
formation created a potent mixure that fed the growth of 21st Century. He attributes much of it to the globalization of
anecdotism, and led to confusion in many who sought to information without any gatekeepers, but he also blames
find credible information on COVID-19. For every finding the “increasing irrelevance of overly narrow research in the
reported in the literature or through other outlets, it seemed social sciences.” Biomedical publications are not immune
there was a corresponding study that refuted the finding. to narrow and irrelevant studies that provide fodder for
This is not a recent phenomenon, as anyone who follows counterarguments to established medical dogma.
the biomedical literature knows. Disagreement is common,
and it benefits science. However, the controversy has been As Laboratory Medicine concludes its 50th Anniversary cele-
greatly magnified by the constant stream of information, bration, I am reminded that never has the biomedical litera-
valid and false, about the COVID-19 disease that floods ture been more important than it has been this past year. In
websites and social media. It is human nature to believe in- its 50 year history, this journal has never seen anything even
formation that reinforces preconceived notions, a tendency remotely as momentous as the COVID-19 pandemic, which
psychologists call confirmation bias. Even scientists are has put in sharp focus our responsibility to rapidly dissem-
not completely free of confirmation bias, but we constantly inate beneficial information about the disease. I have great
strive to objectively assess the existing evidence, and draw confidence in the integrity of our editorial board and the
conclusions based on its relative strengths and weak- double-blinded peer review process, and we will continue to
nesses. We all would like to believe that a simple solution publish only the highest quality research, case reports, and
to the pandemic exists, but many of us work in hospitals reviews. Doing so, I sincerely believe, is our greatest, and
where the futility of simple cures is evident. perhaps only, defense against anecdotism. LM

Roger L. Bertholf, PhD


Editor in Chief, Laboratory Medicine

556  
Lab Medicine 2020;51;555–556 www.labmedicine.com
DOI: 10.1093/labmed/lmaa093

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