Sensitivity, Specificity, and the Art of Seeking Truth

In this newsletter, my goal is to be as accurate as possible. This is in part because it fits my personality, and in part because I feel a lot of what I’m setting out to do (e.g., being a bridge for new ideas to establish themselves) is only possible if I prioritize that (somewhat analogously to Musk designed Twitter’s AI to be “maximally truth seeking”). This is essentially why I spend a lot of time looking into things I discuss here and why I do not cover a lot of topics people want me to, as in many cases, I ultimately do not know what’s actually true there, and hence can’t see a way to ensure my take is accurate.

The problem, however, with that goal is that 100% accuracy is essentially impossible to ever achieve, and if you place too much of an emphasis on trying to reach it (e.g., spending days going down each possible rabbit hole on a simple idea you are considering) it’s not possible to get anything done, much in the same way readers here would greatly prefer 52 articles, each of which I spent a week on rather than me spending a year polishing and refining 1 of them. The All In One Amish S... Zook, Ephraim Check Amazon for Pricing.

The dilemma I just outlined touches every part of life. For example, to navigate the world, we hold thousands of unquestioned beliefs (axioms) we assume to be true at any given moment (e.g., that the solid ground ahead of you will support you when you step onto it, that it’s a good idea to let your lungs inhale and exhale, or that the person sleeping next to you is indeed your spouse), and were we to instead constantly question each one, it would be impossible to function at all in life.

Conversely, a very strong case can be made that many of the problems people run into in life are a result of the unquestioned assumption they have. In parallel, one of my longstanding observations has been that individuals with the cognitive capacity to turn off auto-pilot and recognize which automatic assumptions or behaviors they carry merit re-examination tend to be much more successful in life.
Note: a major problem with medicine is that from day one, doctors in training are taught axioms which exclude the possibility of natural or spiritual healing occurring and hence become rigidly anchored to the lucrative materialistic medical paradigm our society follows.

Lastly, it bears mentioning that a nihilistic school of philosophy (solipsism) essentially argues that it is impossible to know anything with certainty as a sliver of doubt exists behind virtually every axiom you hold (e.g., consider the examples I mentioned above). That line of reasoning is very attractive and is routinely used in debate to dismiss all types of arguments, but inevitably collapses into an endless abyss of absurdity that is immune to outside criticism. This concept is important to highlight as while we should always question things, one should always be mindful of how probable each contrary claim or argument is and to avoid the strings of improbable ones stitched together which lack any corroborating evidence regardless of how aggressively those who share it promote it.
Note: one helpful framework to examine these claims is that after acknowledging they are possible, to ask if they are probable, as in every circumstance there are an endless number of possible (but highly improbable) claims that could attributed to what happened.

Chain Letters

In the mid-1990s, as the internet was starting to see widespread adoption, the “chain letter” phenomenon took off, where a compelling and shocking story would be found in an email from a friend you’d be compelled to forward to other people. After forwarding a few and someone scolding me, it occurred to me they might not be true, so I began researching the ones I received and quickly realized give or take every one was demonstrably fake.

However, despite pointing this out, friends and coworkers kept sending them to me, as the chain letters were designed to always make you feel emotionally compelled to share the email before you wanted to make the mental effort to think about it and vet it. As such, I soon came to the conclusion that “if the improbable events described are too perfectly lined up for a viral story, it is probably fake.” In turn, no matter how the internet has evolved since, that rule has basically always held true. The First-Time Gardene... Sowards, Jessica Check Amazon for Pricing.

Similarly, I found that virtually every social group would have a much lower standard of proof for stories which conformed to (or supported) their existing beliefs than those which questioned it. This is most commonly observed in politics, as individuals will frequently notice instances where members of the other political party do this, but it also exists in many other spheres (e.g., a major problem in medicine is that the medical field readily adopts false narratives which support its prevailing biases while simultaneously reflexively refuses to consider those which affirm a competing paradigm). Finally, members of the group, to fit in, will frequently parrot these stories and narratives to each other and in many cases, also share them outside the group to bolster their group’s social standing.

This dynamic can also be more subtle, as rather than it just being an idea held by members of a group clearly in alignment with the idea, it is also done on an individual level where it’s challenging for an outside observer to see what group the individual is affiliated with. Similarly, in writing this publication, one of the major challenges I’ve run into is discovering that numerous stories or narratives I’ve always believed were true actually aren’t and need to first be vetted. I’d like to think I’ve gotten better at this, but a correspondence from a reader highlighted this is not always the case.

James Sims

Critiques of Western medicine (along with Wikipedia’s list of unethical human experiments), for as long as I can remember, have frequently included James Sims. This is why in last week’s article I stated:

Another controversial doctor James Marion Sims, who in 1845 began experimental gynecological surgeries on black slaves (without anesthesia—and operated on some individuals up to 30 times) and after roughly 4 years of work, perfected the surgeries enough to use them on white women (with anesthesia) after which, in the 1850s, he opened the first women’s hospital (which was mired in controversy due to how barbaric some of his procedures were, their high fatality rate, and some of the unnecessary brain surgeries he did on black children). Nonetheless, he became one of the most famous doctors in the country (e.g., he was the 1876 president of the AMA) and is considered to be the father of gynecology.

Note: many critiques of Sims are far more scathing and graphic and in 2018, after sustained protest from groups like BLM, Sims’s statue in NYC was taken down.

After publishing the article, I received this email from a reader:

Thank you for the wonderful articles you have written. I have shared them with colleagues who share similar concerns and philosophies. I am a retired Neurosurgeon [redacted]. I appreciate and share your thoughts about organ donation. I was heavily involved in brain death testing, and had a personally traumatic experience with a patient who underwent harvesting post cardiac arrest.

I recently read your article about current OB/GYN health care. Excellent. I have attached an article about Dr. J Marion Sims. Wiki has a brief history of Dr. Sims. There are some nuances to his history.

After seeing that, my immediate thought was “oh dear, have I been telling a lie about James Sims for decades?” followed by “I never thought about it before, but I have been emotionally invested in believing a negative narrative about James Sims because the story I heard was so personally triggering for me that I did not vet it first” (not unlike what compels one to share chain letters). Vital Proteins Collage... Check Amazon for Pricing.

I then read that article (which you can too here) and found out that:

• Most of the above allegations against Sims are not supported by the historical record or the clinical reality of the time (where many things we take for granted now instead were very difficult to do). Rather, they were strung together to support a narrative of white doctors ruthlessly exploiting black slaves.
• The gynecologic condition Sims was treating—vesicovaginal fistula (and other similar ones)—were devastating for those who had them and incurable at the time, so the enslaved women he operated on were desperate for relief and willingly consented to the procedures.
• Sims didn’t use anesthesia mainly because ether was still brand new, highly controversial, and carried real risks. He (and other surgeons) didn’t think the pain of these particular operations justified the dangers, and he applied the same standard to white patients as well.
• The surgeries he developed were the first consistently successful repair for this condition and basically founded modern gynecologic surgery, which is why he rose in the field.
• A lot of Sims’s behavior toward these women lines up with someone genuinely trying to help them rather than just exploiting them—he operated at his own expense, got their cooperation (they even assisted in each other’s surgeries), publicly acknowledged his debt to them, and kept going because they pushed him to continue when he wanted to quit.

So, I have to say I never expected to defend someone I despised as much as Dr. Sims, but since my priority is being accurate, I felt I needed to as I lied about him in the previous article.

Note: many other criticisms have been leveled against Sims besides the one I touched upon. They may be valid; my point is only on correcting what I was inaccurate about.

Sensitivity and Specificity

One of my favorite concepts in the philosophy of science is “sensitivity and specificity.” This dyad denotes how likely you are to identify what you are trying to get (sensitivity) and how likely you are to erroneously misidentify your target (specificity). In medicine, this concept is raised to highlight that no diagnostic test is perfect, and if you prioritize one of these, you typically worsen the other (e.g., if a cancer test is too liberal with its criteria, it will cause issues by falsely diagnosing people with cancer whereas if you design a test to avoid false positives, it typically will also have a higher rate of missed cancers). THORNE Creatine - Micr... Check Amazon for Pricing.

Because of this, a major focus in diagnostic testing is to identify which tests have the best balance between the two, and to identify which situations merit tests which emphasize sensitivity and which merit tests that emphasize specificity (or a combination of both). Conversely, some of the biggest debacles in medicine result from this principle being disregarded. For example, to ensure the COVID nasal PCR tests did not miss any cases of COVID, their sensitivity was raised to the point they frequently had false positives to the point large segments of the population concluded the tests were a complete joke.

After I was introduced to the concept of sensitivity and specificity, it dawned on me this concept extended far beyond medical diagnosis, and underlies many different challenging situations faced by our society. For example, much of the debate with criminal justice and police boils down to prioritizing sensitivity (preventing as many criminals as possible from harming the population) or specificity (not falsely arresting and harming innocent individuals), and once one goes too far to either extreme, clear issues happen on the other hand (e.g., a culture of lax policing and prosecutions spikes violent crime whereas authoritarian societies that believe in guilty until proven innocent have populations who are terrified of the police and many innocent prisoners).

Unfortunately, once these debates become contentious issues, rather than the goal being to find the best way to maximize sensitivity and specificity, one side will typically identify with the sensitivity position, the other with the specificity position, and then each will be excellent at arguing for why greater sensitivity (or specificity) is needed but simultaneously incapable of seeing the downsides to their position on the other end of things. Ultimately, things typically settle out in a compromise position where the way sensitivity and specificity are addressed is “good enough” (rather than a rationally designed one aimed to maximize both), and in times when the society becomes more polarized, shifts more towards one or the other, and then later inevitably goes back in the opposite direction once the flaws of the previous became clear, and either societal polarization decreases or the opposite side comes to power.

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