Information Age Education
   Issue Number 168
August, 2015   

This free Information Age Education Newsletter is edited by Dave Moursund and Bob Sylwester, and produced by Ken Loge. The newsletter is one component of the Information Age Education (IAE) publications.

All back issues of the newsletter and subscription information are available online. In addition, five free books based on the newsletters are available: Education for Students’ Futures; Understanding and Mastering Complexity; Consciousness and Morality: Recent Research Developments; Creating an Appropriate 21st Century Education; and Common Core State Standards for Education in America.

This is the 15th IAE Newsletter in a series on Credibility and Validity of Information.

Credibility and Validity of Information

Part 15: Medicine

David Moursund
Emeritus Professor of Education
University of Oregon

The discipline of medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, prostheses, biologics, and ionizing radiation (Wikipedia, n.d.).

The definition given above is often called standard medicine or standard care. Complementary and alternative medicine (CAM) is the usual term for medical products and practices that are not part of standard care (Complementary and alternative medicine, n.d.).

In the United States, more than one-sixth of the yearly total gross national product is now spent on health care. The estimated expenditure for year 2015 is about $10,000 per person. In total, our medical expenditures now exceed $3 trillion a year! It is appropriate to ask about the credibility of people who offer health care and advice about health care.

It is also appropriate to ask about the validity of the practices they employ, the information they use, and also the proved effectiveness of the medicines they dispense. The health care system is governed by a huge number of laws, rules, and regulations. Nevertheless, it has its share of unethical and/or poorly prepared practitioners and ineffective treatments.

My 8/27/2015 Google search of the term quack medicine produced nearly 3.9 million results. The short message is, “Let the buyer beware.” As an example, think about the innumerable ads you have viewed and read about weight loss programs. Many people continue to want to believe in a magic pill or magic program for weight loss. My personal belief is that if there were a safe, easy-to-use, and not overly expensive “treatment,” it would be well supported by good research and widely available. So far, no such luck.

Throughout this health care system, people make decisions based on the knowledge and beliefs they have, and the information resources they can access. This newsletter takes a brief look at the credibility and validity of the information that is used to make health care decisions. The goal is to help you—an individual reader—to make better decisions and to better appreciate the complexities inherent to any health care system. Of course, we hope you will share your increased knowledge with your students and others.

Comparing Health Care and Education

Most readers of the IAE newsletters are educators. As educators, we realize that education is both an art and a science. The art is displayed by millions of individual human teachers in their day-to-day interactions with their students. The science comes from a substantial amount of education and cognitive neuroscience research. Substantial progress is occurring in implementing some of the science of teaching and leaning via computerized, intelligent teaching machines. IAE published a seven-newsletter series comparing health care and education in 2010 (Education and Health Care, parts 1-7, 2010).

As you read this current newsletter, consider the parallel between the art and science of education, and the art and science of health care. Think about the complexities of improving either of these gigantic and complex systems!

Medicine Is Not an Exact Science

Although the “science” of medicine is large and growing, medicine is by no means an exact science. Moreover, the problems that medicine is addressing are very complex. The daily media has made this clear in its coverage of cancer, Alzheimer’s and other dementia, autism, Ebola and other viruses, etc.

While most of us would like to believe that a magic pill, shot, vaccination, or other similar treatment will always work for each of these health problems, that definitely is not the case today. Nor is this apt to be the case for a great many years to come.

We do have some very effective preventative treatments. Quoting from The History of Vaccines (n.d.):

Individual immune systems, however, are different enough that in some cases, a person’s immune system will not generate an adequate response.

That said, the effectiveness of most vaccines is high. After receiving the second dose of the MMR vaccine (measles, mumps and rubella) or the standalone measles vaccine, 99.7% of vaccinated individuals are immune to measles. The inactivated polio vaccine offers 99% effectiveness after three doses. The varicella (chickenpox) vaccine is between 85% and 90% effective in preventing all varicella infections, but 100% effective in preventing moderate and severe chicken pox.

For various reasons, some people want to opt out of having their children vaccinated and/or receive other forms of medical treatment. These people make a decision based on their knowledge and beliefs, yet this knowledge may well be based on information that is not valid. If enough children in a certain locality fail to receive a particular vaccination such as the MMR vaccine, a local epidemic is possible. So, we have a medical, religious, legal, and political conflict between the good of the many versus the rights of the individual.

Here is a somewhat similar example. Those of us who have grown up depending on the effectiveness of antibiotics are dismayed by the current growing ineffectiveness of widely used antibiotics (Boseley, 4/30/2014). Our misuse and overuse of some of these antibiotics has led to this decline in their effectiveness. Quoting from the article:

Antibiotic resistance is a major threat to public health, says the World Health Organization (WHO). It is no longer something to worry about in the future, but is happening now and could affect anybody, anywhere, of whatever age.

"Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Dr Keiji Fukuda, the WHO's assistant director general for health security.

Decision Making Under Uncertainty

Because medicine and medical treatments are by no means an exact science, the decisions made at every level of medical care can be thought of as being decision making under uncertainty.

Suppose I am not feeling very well today. Should I: call 911; go to an Urgent Care facility; schedule an appointment with my doctor; call a friend and ask for advice; go to work anyway; just stay home and continue to monitor the situation; or decide on some other action? One approach is to think about the consequences of each of your possible decisions.

For example, suppose you know some of the symptoms of a heart attack, and you think you might be experiencing some of these symptoms. Calling 911 might save your life. The decision you make will depend on your accumulated knowledge and experience.

So, you first draw on information stored in your head. How valid and up to date is it? Next, you think about accessing other sources of information. For example, you may take your temperature and check your heart rate. You may think carefully about your symptoms, and use the Web or other information source to look up information on possible meanings of these symptoms.

If the information resources you use are valid and you understand the information they provide, you are apt to make a better-informed decision. This observation supports the value of all students receiving sufficient health care education so they can make effective use of information resources that are generally available.

Growing Availability of Relatively Good Sources of Information

Many of us grew up with the medical help of Dr. Benjamin Spock (Spock, n.d.). Quoting from the reference:

Benjamin McLane Spock (May 2, 1903 March 15, 1998) was an American pediatrician whose book Baby and Child Care, published in 1946, is one of the best-sellers of all time. Its message to mothers is that "you know more than you think you do."

Now we have access to many websites that are credible and strive to provide valid information. Here is a short list in alphabetical order; it is not intended to be a definitive list.
Part of your personal health care education, and that of your students, should include learning to make use of sources like these and/or others that you believe offer valid information. They also should be sources that you can communicate with effectively.

IBM’s Watson: Part of the Future of Medicine

IBM’s computer system named Watson is well known for defeating two human champion players of the TV game Jeopardy in 2011 (Best, n.d.). Since then the hardware of this computer system has been vastly improved, and large teams of researchers and practitioners have been developing software and databases to apply this compute power to a variety of problems.

The general ideas behind Watson learning to play Jeopardy have been expanded into Watson learning to read and process both the medical research literature and individual patient records. Today, Watson is already showing its promise to significantly help in improving our health care system.

The U.S. National Institute of Health reports that it is now processing more than 700,000 new citable medical articles per year, and that its total library now contains 21 million articles (NIH MEDLINE, 2015). The current Watson medical system is designed to read and process such literature. Its “intelligence” in processing this literature, and then making use of it to analyze an individual patient’s records, is growing steadily.

Quoting from Putting Watson to Work (IBM, n.d.):

In fact, the amount of medical information available is doubling every five years and much of this data is unstructured—often in natural language. And physicians simply don't have time to read every journal that can help them keep up to date with the latest advances—81 percent report that they spend five hours per month or less reading journals.

Watson uses natural language capabilities, hypothesis generation, and evidence-based learning to support medical professionals as they make decisions. For example, a physician can use Watson to assist in diagnosing and treating patients. First the physician might pose a query to the system, describing symptoms and other related factors. Watson begins by parsing the input to identify the key pieces of information. The system supports medical terminology by design, extending Watson's natural language processing capabilities.

Watson then mines the patient data to find relevant facts about family history, current medications and other existing conditions. It combines this information with current findings from tests and instruments and then examines all available data sources to form hypotheses and test them. Watson can incorporate treatment guidelines, electronic medical record data, doctor's and nurse's notes, research, clinical studies, journal articles, and patient information into the data available for analysis. [Bold added for emphasis.]

This is a truly amazing project!

Final Remarks

Remember, medicine is not an exact science. The decisions that health care workers and those receiving health care make can be thought of as decision making under uncertainty. Through education, experience, and drawing on valid sources of information, health care workers and recipients can make better decisions. Through continuing research and development, our health care system can continue to be improved.

It is clear that patients and health care professionals are becoming more and more dependent on the use of computers in health care. Eventually a person at home who has a medical care problem will be able to talk (via voice) to a Watson-type computer system rather than “merely” looking up information on the Web. That does not resolve the issue of the credibility of the information source and the validity of the information and recommendations it provides. This leads to a question I frequently hear, “Who gets sued if something goes wrong?”

I find it interesting to ask the same question about our educational system. It is quite clear that some children get a much better education than others. While growing up, a child receives years of informal and formal education at home, in the community, and at school. On average, children growing up in poverty get a poorer informal and formal education than those growing up in greater affluence (Moursund, 5/2/2014).

I find the average $10,000 per person per year of medical expenses somewhat overwhelming. But, it now costs an average of more than $11,000 per student per year for public precollege education. The U.S., like every nation, faces the problem of how to allocate its resources in order to best meet the needs of its citizenry. The steadily growing costs of medical care and education in the U.S. are cutting into the resources available for meeting other needs of its population.

References

Best, J. (n.d.). IBM Watson: The inside story of how the Jeopardy-winning supercomputer was born, and what it wants to do next. Tech Republic. Retrieved 8/27/2015 from http://www.techrepublic.com/article/ibm-watson-the-inside-story-of-how-the-jeopardy-winning-supercomputer-was-born-and-what-it-wants-to-do-next/.

Boseley, S. (4/30/2014). Antibiotics are losing effectiveness in every country, says WHO. The Guardian. Retrieved 8/27/2015 from http://www.theguardian.com/society/2014/apr/30/antibiotics-losing-effectiveness-country-who.

Complementary and alternative medicine (n.d.). MedlinePlus. Retrieved 8/27/2015 from http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html.

Education and Health Care, parts 1-7 (2010). IAE Newsletter. Retrieved 8/27/2015 from http://i-a-e.org/iae-newsletter.

IBM (n.d.). Putting Watson to work. Retrieved 8/27/2015 from http://www-03.ibm.com/innovation/ca/en/watson/watson_in_healthcare.shtml.

Moursund, D. (5/2/2014). Hungry children—America’s shame. IAE Blog. Retrieved 8/27/2015 from http://i-a-e.org/iae-blog/entry/hungry-children-america-s-shame.html.

NIH MEDLINE (2015). Fact sheet. U.S. National Library of Medicine. Retrieved 8/27/2015 from http://www.nlm.nih.gov/pubs/factsheets/medline.html.

Spock, B. (n.d.). Wikipedia. Retrieved 8/27/2015 from http://en.wikipedia.org/wiki/Benjamin_Spock.

The history of vaccines (n.d.). College of Physicians of Philadelphia. Retrieved 8/27/2015 from http://www.historyofvaccines.org/content/articles/top-20-questions-about-vaccination#1.

Wikipedia (n.d.). Medicine. Retrieved 8/27/2015 from https://en.m.wikipedia.org/wiki/Interdisciplinary_sub-specialties_of_medicine#Interdisciplinary_fields.


Author

David Moursund is an Emeritus Professor of Education at the University of Oregon, and coeditor of the IAE Newsletter. His professional career includes founding the International Society for Technology in Education (ISTE) in 1979, serving as ISTE’s executive officer for 19 years, and establishing ISTE’s flagship publication, Learning and Leading with Technology. He was the major professor or co-major professor for 82 doctoral students. He has presented hundreds of professional talks and workshops. He has authored or coauthored more than 60 academic books and hundreds of articles. Many of these books are available free online. See http://iaepedia.org/David_Moursund_Books. In 2007, Moursund founded Information Age Education (IAE). IAE provides free online educational materials via its IAE-pedia, IAE Newsletter, IAE Blog, and books. See http://iaepedia.org/Main_Page#IAE_in_a_Nutshell.

Email: moursund@uoregon.edu.

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Information Age Education is a non-profit organization dedicated to improving education for learners of all ages throughout the world. Current IAE activities and free materials include the IAE-pedia at http://iae-pedia.org, a Website containing free books and articles at http://i-a-e.org/, a Blog at http://i-a-e.org/iae-blog.html, and the free newsletter you are now reading. See all back issues of the Blog at http://iae-pedia.org/IAE_Blog and all back issues of the Newsletter at http://i-a-e.org/iae-newsletter.html.