Big data and big experience

If you’re interested in the value and suppression of ivermectin in the treatment and prevention of COVID infection (and in the treatment of long COVID and long-post-vaccine syndromes), there’s an excellent, and extremely long, long-form discussion here between Pierre Kory and Brett Weinstein.

Understandably a significant part of the video discusses the censorship of all information about the efficacy of this drug, which I’ve discussed before. Indeed, the host Weinstein begins by challenging YouTube to think twice before censoring a scientific conversation between the doctor whose ICU protocols for COVID have been adopted as the standard, and an evolutionary biologist whose rational consideration of the lab-leak hypothesis over many months has now become mainstream.

Even so, YouTube has given the video a health warning that directs us to the NHS for authoritative information. Having spent a career working for or contracted to the NHS, I prefer listening to the independent professionals over the political bureaucrats.

I won’t deal with the full content of the discussion, because if you’ve followed the ivermectin story at all, even on The Hump, you’ll already have the big picture of the science and the grand-scale corruption already. The conversation in the video is worth your investment of time if you’re interested, though. Instead I will concentrate on one small point that relates to my long term interest in the theory of knowledge.

Kory, you must understand, is a much-published world leader in the field of intensive care medicine – what Weinstein (citing his brother) calls a “Knarc” (the polar opposite of a Crank!). He describes how his skills developed through countless encounters with patients in extremis, whom he learned to bring back from the brink, making vital decisions “sometimes on almost no evidence” about their situation. After a few years of such management, obviously based on the best science, though often without that science being available for the individual patient, he says that he acquired an ability to assess what was the matter with them almost at first sight.

The ability was based on a process of pattern-recognition, quite often at an unconscious level. This goes far beyond any list of clinical features of particular conditions in textbooks, and even more beyond the algorithmic check-lists so favoured in medical triage nowadays. Naturally enough, it becomes increasingly tuned over the years, building up to that indefinable professional skill of “expertise.” Incidentally, it is that “pattern recognition” that another COVID “heretic”, the former Pfizer research VP Dr Mike Yeadon, recognises as his main claim to relvant expertise.

When Kory describes this skill, Weinstein replies enthusiastically that the same is true amongst evolutionary biologists, the best of whom acquire the ability to see patterns in evidence that lead, far more often than average, to valid predictions. It is this ability, more than an ability to trawl the literature, that distinguishes the great scientist who generates progress in the field.

At this point in the video, I wanted to shout out “Michael Polanyi!” because this is exactly his concept of “personal knowledge,” which I came across back in 2014. Polanyi argues that there is no branch of human endeavour, including science, in which “traditional skill” does not play a vital role, particularly in distinguishing between the master craftsman and the mere technician.

Pierre Cory (like many others including myself) laments the present-day eclipse, in medicine, of such expertise gained by experience, by authoritative diktats from central authorities, usually long-separated from the on-the-ground practice that builds professional expertise.

In the case of ivermectin (assuming, too charitably, the absence of ulterior financial or ideological motives) the insistence that only large-scale random-controlled trials can legitimize its use ignores the centuries of experience of the leading clinicians convinced it could stop the pandemic in its tracks, and save many thousands or millions of lives.

I identify strongly with this. My own field of general practice obviously involves far fewer encounters with patients verging on death. But it involves far more enounters, numerically, and they are entirely unselected. I estimate that I had something like a quarter of a million one-to-one patient consultations during my career, the majority face-to-face.

No amount of training (in my case 6 years of university and medical school, 14 months of pre-reg hospital jobs and three years of GP job rotation) can prepare one for the patient walking in off the street whose story matches nothing you have learned from the books or on the wards. And yet the job spec is to deal competently with that individual, firstly excluding what may be a hidden manifestation of something life-threatening, or what at the other extreme might be pure malingering. Ongoing familiarity with individual patients and families, of course, also forms a deeper understanding both of what is likely to be wrong, and what is likely to help, for that person.

One’s “personal knowledge” (for which my preferred term was “nous”) grows extremely rapidly under those circumstances, which I suspect was deliberately inculcated in the training methods of former days. These fostered confidence in individual decision making, with incomplete information, over gaining certainty before taking action. “See one, do one, teach one,” was a hoary professional joke, but demonstrated the truth that, in real life, there may be no possibility of attending a training course where “best practice” is infallibly established. In any case “best practice,” like fashion, sometimes goes through several cycles during a single career.

Towards the end of my time, the conflict between that deeply human skill-set (and ethos) and the guidelines passed down as mandatory from the NHS and the professional bodies, based on a rather truncated view of “evidence-based medicine,” became ever clearer. It was truncated because it favoured the number-crunching of big data – mostly collected by those paid by Big Pharma promoting new drugs, over any consideration of either the individual’s needs, or the individual skills of the professional “scientific doctor” gained from on-the-ground experience. And it was authoritarian because payments were based on compliance, and increasing “professional assessment” centred on how closely one toed the official NHS line.

This conflict is now coming to a head throughout science, it seems. In COVID, the individual scientist assessing the evidence he or she sees, and measures, in the real world is confronted with the concerted exercise of a monlithic suppressing authority that seems worldwide. This works through umbrella organisations like the WHO, governments and their paid scientists, large corporations and NGOs, and of course the press and the social media. Most directly it works through the “professional” bodies like the GMC or the NMC (for nurses) and the various specialty colleges, who seem bent on directing armies of obedient technicians and quenching professionalism.

Such authoritarian control of intelligent and open-minded professionals has also been noted in other fields like climate science and energy technology, in the study of sexuality and gender, and, I dare saty, in Weinstein’s own field of evolutionary biology – though he may not have been aware of it if he happens, in this case, to be in agreement with the ruling majority. Wherever it occurs, it destroys “personal knowledge,” and therefore professionalism itself.

I think it is helpful, as Weinstein and Kory do at the start of this video, to view this in terms of a contrast between the now-favoured Big Data, which lends itself so well to technocracy and, increasingly, Artificial Intelligence, and the fundamentally human phenomenon of expertise gained through “personal knowledge.” This contrast invites us to recognise the difference wherever it arises, whether in the reliance on complex models run on supercomputers at the expense of professional scientific “nous,” or in the generation of pop music or TV drama by trendy young people with eyes on ratings, rather than by artists who know about life because they have lived it.