Why are assumptions passed off as established knowledge?, 2020, Weisman et al

Dolphin

Dolphin

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https://www.sciencedirect.com/science/article/abs/pii/S0306987720302437
Medical Hypotheses
Available online 24 March 2020, 109693
In Press, Journal Pre-proof
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Why are assumptions passed off as established knowledge?

Asaf Weisman a
John Quintner b
Melanie Galbraith c
Youssef Masharawi a
https://doi.org/10.1016/j.mehy.2020.109693
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Abstract
In this paper we attempt to explain the problems that can arise when assumptions made by experts in their respective fields of Medicine become widely accepted as established knowledge. Our hypothesis is that these problems are in large part attributable to a failure of the experts to follow the principles of logical argument.

Empirical data to evaluate our hypothesis derives from an analysis of the reasoning processes employed in the generation of three syndromes drawn from the clinical discipline of Pain Medicine: myofascial pain, shoulder impingement and central sensitisation.

We demonstrate a failure by the proponents of these syndromes to structure their scientific arguments in a logically valid fashion, which lead them to promote assumptions to the status of facts. In each instance those in relevant scientific journals responsible for content review accepted – and thereby promulgated - this fundamental error in reasoning. The wide acceptance of each of these assumptions as established knowledge affirms our hypothesis. Furthermore, we show that such uncritical acceptance has had significant consequences for many patients.

Keywords
assumptions
facts
testable hypotheses, musculoskeletal medicine
myofascial pain syndrome
trigger points
impingement syndrome
central sensitivity syndrome
central sensitisation
pain
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Nothing specific about ME other than the fact that some people somewhere include it in their personal model of CSS.

It's a necessary discussion but it's still very worrying that the way this is discussed is about the way one would look at a place completely trashed by a rabid badger and meekly, avoiding saying anything that could be construed as confrontational, asking whether it's valid to ponder about the presence of a rabid badger in the first place (and don't mind the bodies or the slippery floor).

So we are still very far from solving the problem, we are still at the phase where some people dare not raise their voice and whisper whether it should eventually be considered as a problem.

It's a good piece overall, but it is discussed mostly as a philosophical dilemma, rather than a very real human rights disaster of choice brought about by a broken process of medical evidence that willfully dismisses the actual experience of those complex problems and substitutes them with invalid assumptions that exist only to support a belief system custom-built to provide a narrative out of limited evidence, rather than actually attempting to solve it.

This is most of what is relevant:
This proposition contained three scientifically tenuous themes:
  • Firstly, central sensitisation of nociception was adopted as the model from which an unjustified generalisation to “central sensitisation” was made.
  • Secondly it was stated that the biology of CSS is “based on neuroendocrine aberrations (including CS) that interact with psychosocial factors to cause a number of symptoms”, without evidence being offered.
  • Thirdly, “long-term CNS plasticity” was invoked for the ability of CS to sustain itself, which is a circular argument.
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Still a very long way to go...
 
Of the three authors of the paper, one has a PhD, the other two are physical therapists.

They don't have the necessary scientific or medical credentials to pontificate on these hypotheses.

I was grateful back in the late 1990s for any research, any hypothesis about fibro. Yunus was a hero to me.

Yes, these hypotheses are old, but saying that long-term CNS placiticity for maintaining Central Sensitivity is a circular argument, is false.

Once the sensitization occurs it is maintained by abberrant plasticity, a positive feedback loop.

These authors are commiting their own fallacy through their lack of knowledge.
 
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I don't claim to know whether central sensitisation has any biological validity, but I would be wary of saying it's a good hypothesis on the grounds that it provides an explanation that some patients find helpful because seems to make sense of our symptoms.

I think I may have misunderstood you, @shak8. Is central sensitisation something that can be, and has been tested by scans or biochemical tests? From the little I've seen about it, it seems to be still an unproven, and possibly unprovable hypothesis. I'd be glad to be shown to be wrong.
 
Trish said:
I don't claim to know whether central sensitisation has any biological validity, but I would be wary of saying it's a good hypothesis on the grounds that it provides an explanation that some patients find helpful because seems to make sense of our symptoms.

I think I may have misunderstood you, @shak8. Is central sensitisation something that can be, and has been tested by scans or biochemical tests? From the little I've seen about it, it seems to be still an unproven, and possibly unprovable hypothesis. I'd be glad to be shown to be wrong.
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As far as I know (and that is little) is it an hypothesis only.
 
Snow Leopard said:
What published studies have you seen to support the claim that this occurs in humans?
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The upregulation of sensory input to the somatosensory cortex for whatever reason, results more and more noxious sensation which feed more sensory inputs to that brain center resulting in a feedback loop.

This phenomenon as well as a ton of other research articles about CSS exist on PUBMED.

What is the alternative to this regarding the inciation and maintanence of chronic pain?
.
 
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I know in my field of work assumptions tend to be made because they're convenient - i.e. I want the world to work a certain way so I'll assume it does.

Made to test knowledge - we don't quite understand what's happening here so we'll assume x=y and try to break that assumption. If it proves true then we do one thind, if it's false we do something else. Or we learn something entirely new and may adapt based on that new knowledge.

Not checking whether assumptions are true is generally down to laziness and can end up costing someone a lot of money.

I have no idea why in medicine it's just okay to just carry on assuming without ever proving the base assumption, then building an empire entirely founded on assumptions.
 
shak8 said:
The upregulation of sensory input to the somatosensory cortex for whatever reason, results more and more noxious sensation which feed more sensory inputs to that brain center resulting in a feedback loop.

This phenomenon as well as a ton of other research articles about CSS exist on PUBMED.
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I have seen a lot of hypotheses, but not evidence.

The studies on c-fibres for example, only show increases in sensitivity across very short time spans, and neglect the fact that there are other feedback mechanisms that soon serve to correct prolonged sensitisation.
 
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