Meaning is Expensive

Source: xkcd

On the morning of January 20, 2015, Stephen Pasceri, a 55-year old accountant, called in sick to work and left his suburban home without saying goodbye to his wife. He left behind a thumb-drive filled with medical “research” and drove to Brigham and Women’s Hospital in Boston.

The previous fall, Pasceri’s mother had undergone surgery there, performed by Dr. Michael Davidson, the hospital’s director of endovascular cardiac surgery, a professor at Harvard Medical School, a specialist in high-risk patients, and the father of three children (with a fourth on the way). However, Marguerite Pasceri died some weeks later at another hospital. Her death certificate listed her cause of death as “cardiovascular collapse” caused by her preexisting illnesses, including multiple heart surgeries, and exacerbated by a lifetime of Newports.

Stephen Pasceri knew better.

After much internet surfing, Pasceri decided that amiodarone, a commonly prescribed post-operative medication for patients suffering from an irregular heartbeat, had killed his mother. Dr. Davidson had prescribed that medication. “It’s very unlikely that she died of amiodarone,” said Dr. Philip Newman, a board-certified cardiologist and long-time practitioner who is an associate professor of medicine at the University of California–Irvine. “[Dr. Davidson] did everything right.” Notwithstanding expert opinion, Pasceri was “certain” that Dr. Davidson was responsible for his mother’s death.

On that brisk winter morning, Pasceri arrived at the hospital unannounced, wandered aimlessly for about an hour, and then demanded to see Dr. Davidson. “I’m not leaving without seeing him,” he said, over and over. Despite a busy schedule that had to be rearranged, the doctor – well known for his patience and good bedside manner – sat with Pasceri to listen to a grieving son and to explain what he had done and why.

Almost immediately, Pasceri referenced his internet study and accusingly asked, “Are you aware that this drug is extremely toxic?” When Dr. Davidson explained that he was well aware of the side effects and that his mother had been monitored carefully, Pasceri did not seem to hear and repeated his accusations, again and again. “Well, my mother died because of this,” he said.

The last half of the conversation was unwitnessed, but after meeting for nearly 40 minutes in total, two blasts from a .40-caliber pistol rang out. Dr. Davidson burst from the room, clutching his wounds and yelling, “Run. Run. He’s shooting, he’s shooting!” Meanwhile, Pasceri shoved the gun into his mouth and pulled the trigger. Pasceri died at the scene. After more than eight hours of emergency surgery, Dr. Davidson was pronounced dead.

Pasceri’s thumb-drive, full of internet “research,” had starkly announced his intentions: “The doctor is dead. I am dead. There is nothing more anyone can do.”

Modern technology has made it possible to access essentially all human knowledge via a machine that fits in a shirt pocket and is readily available to almost anyone. However, there is at least as much garbage available – and that is often much easier to find. Moreover, at least for non-experts, it is exceedingly difficult to tell which is which. In today’s world, information is cheap; meaning is expensive.

As physicians Pamela Hartzband and Jerome Groopman described in the New England Journal of Medicine: “Falsehoods are easily and rapidly propagated on the Internet: once you land on a site that asserts a false rumor as truth, hyperlinks direct you to further sites that reinforce the falsehood. Material is perceived as factual merely because it is on a computer screen. We sometimes find ourselves in the uncomfortable position of trying to dissuade desperate and vulnerable patients from believing false testimonials. Doctors may be perceived as closed-minded, dismissive, or ignorant of ‘novel therapies’ when they challenge such Internet rumors.” Scientific American found what should be common sense: “the quality of medical information on the internet varies widely.” Still, “Dr. Google” treats a lot of patients.

Part of the reason discerning internet wheat from chaff (medical or otherwise) can be so maddeningly difficult is because of the way our brains work. Research has now shown that consumers of information on the internet “are not reading online in the traditional sense; indeed, there are signs that new forms of ‘reading’ are emerging as users ‘power browse’ horizontally through titles, contents pages and abstracts” looks for anything they can find that might support their preconceived notions. It is confirmation bias writ large.

When challenged on their erroneous claims, a typical response is that of Jeffrey “The Dude” Lebowski (albeit in a much different context).

A friend – otherwise intelligent and accomplished – recently made a social media post touting “research” critical of vaccinations, despite overwhelming evidence to the contrary. I inquired how she had determined that the medical evidence was wrong. Her reply was striking: the “research” to which the proffered link pointed “confirmed my beliefs.”

Today’s internet “experts” often do not know enough to recognize what they ought to know, much less that they do not know it. Good musicians know when they are out of tune. Bad musicians do not.

Ouch.

The tidal wave of available information made possible by the internet allows far more people far more access to far more information than ever before. However, that access is often not so much the key to knowledge as the basis for the illusion of knowledge, reinforcing the conflation of information, knowledge and experience. When unlimited data sets are available, curation is key. Otherwise, facts and serious analysis readily give way to half-baked opinions, rumors, misunderstandings, crackpot guesswork, downright propaganda, and outright lies.

As I often say, we like to think that we are like judges, that we carefully gather and evaluate facts and data before coming to an objective and well-founded conclusion. Instead, we cut straight to the chase. We are much more like lawyers, grasping for any scrap of purported evidence we can exploit to support our preconceived notions and allegiances.

Understanding only comes – is earned – through training, effort and experience. Despite the ever-increasing onslaught of information, true understanding is at least as valuable as it ever was.