I do a lot of medical writing and it is always a bit like stepping through into another dimension. Serious clinical writing (the kind of stuff that gets published in medical journals or similar outlets) requires not only serious science but real logic.
It’s quite a departure from the world most of us live in. Most Americans know very little science. That problem is compounded by the fact that most of us exercise very little logic. We accept ideas from all over the place (not realizing that some ideas are sounder than others and a few ideas are not sound at all) and then sort of cut-and-paste them together to form some sort of convenient conclusion.
That’s why I enjoy medical writing. It keeps me sharp and makes me realize that many of our assumptions are actually quite flawed and possibly even inaccurate.
For instance, causality versus association. When A causes B, that’s causality. It’s notoriously tough to prove. I think most doctors would agree that physicians have determined that smoking causes cancer, but that was a tough haul because for a long time all we had were “associations.” Smoking was associated with higher rates of cancer, but that’s a far cry from saying smoking caused cancer.
You can see it more clearly with another example. We have sharply increased of childhood obesity. At the same time, we have SpongeBob Squarepants on TV. Those two things are associated. As SpongeBob hit the airwaves, kids got fatter. Does SpongeBob cause obesity? No. But you can sometimes draw absurd associations like that.
Where it gets trickier are the gray areas. Let’s say you’re writing about a clinical trial where some people get drug A, some others get drug B, and the control group gets a placebo. Now let’s say that the people who take drug A wind up with a higher rate of hypertension than the other two groups. Can you really say that drug A causes hypertension? You can’t, although it is possible that drug A does indeed cause high blood pressure. But a study with results like that would, at most, show an association between drug A and higher-than-normal rates of hypertension.
All this brings me back to our desire for fast science. We want to know what foods are good for us, what drugs will help us, the best way to lose weight, even what happens when we die. The trouble is that fast science is almost never good science. We need to sort out a lot of things and think through them clearly. We need to recognize that a lot of factors come into play and we don’t always know what to do with them.
Sometimes, in medicine, you get a momentary shot of genuine clarity. That’s why I like it. Most non-medical writing doesn’t make you work that hard.
