Winning the Hardware Software Game Winning the Hardware-Software Game - 2nd Edition

Using Game Theory to Optimize the Pace of New Technology Adoption
  • How do you encourage speedier adoption of your product or service?
  • How do you increase the value your product or service creates for your customers?
  • How do you extract more of the value created by your product or service for yourself?

Read more...

Latest Comments

  • Anonymous said More
    Well written. Well constructed. Tuesday, 13 August 2019
  • Ron Giuntini said More
    As always a good read.
    I have always... Thursday, 25 January 2018

In 2005, a physician-scientist research pioneer, John Ioannides, published what has come to be a widely circulated paper, “Why Most Published Research Findings Are False.” The replication crisis we’re having in science embodies the concern voiced by Mr. Ioannides. Yet, despite much evidence that so many studies are not valid, scientific professionals continue to rely almost exclusively on study results when deciding on best practices.

So many studies are flawed. As a simple example, please take my survey by answering the following question:

Over the past 12 months, how many times have you visited a doctor?

Take as much time as you need to answer the question…

Got your answer?

Okay, now let me ask you a few questions about the number of visits you just “reported” for my study.

First, to answer my question, did you just think back in your mind, or did you actually check your records? Most people will probably come up with a “good estimate” based on what they can quickly recall. Relatively few people will make the effort to reference records to help them come up with a more accurate estimate.

As for what we remember, researchers continue to discover new ways in which our memories paint an inaccurate portrait of “the truth” (to the extent the truth exists). For example, the telescoping effect is a common cognitive bias affecting our memory, where we tend “to displace recent events backward in time and remote events forward in time, so that recent events appear more remote, and remote events, more recent.” The telescoping effect is just one of many different cognitive biases – Wikipedia lists 42 different cognitive biases that affect our memories – any one of which may cause your reported number of visits to the doctor over the past 12 months to be more or less than the “true” number.

Second, what types of providers did you include in your estimate? Did you include any visits to a dentist, nurse practitioner, therapist, optician, optometrist, pharmacist, herbalist, or other allopathic provider? Different people will have different interpretations of what’s included in the category “doctor.”

Third, if you visited the same “doctor” (however you define it) more than once (perhaps for a follow-up), did you count that as one visit or two? Some people will count multiple visits to the same doctor as a single visit – that is, what they consider “a visit” is more figurative – whereas others will interpret that phrase more literally.

So then what’s the “actual” number of visits to the doctor I’m looking for? How do I define “doctor”? How do I define a “visit”? It depends: what am I trying to measure?

Now that I’ve posed some of the problems with the information I would have collected, how much faith would you put in any findings I would have reported based on analyses of such data? Probably not much, and rightfully so.

Perhaps, that’s a little simplistic. Clinical studies are generally more precise than my little survey study, aren’t they? Perhaps, but not necessarily. Many clinical trials study patient-reported outcomes, such as depression, anxiety, or fatigue. These types of reported outcomes are subjective. Clinical studies are also subject to bias from many different possible sources, most notably selection bias.

Well, then, that’s why we use randomized control trials (RCTs). RCTs are studies that are considered to be the gold standard for establishing “evidence-based” healthcare practices. RCTs control for all the problems potentially associated with other clinical trials, don’t they? Not necessarily. While randomizing a sample and providing a control group eliminate some potential forms of bias, other errors and forms of bias may still be present. In other words, even RCTs may not generate “the truth.”

Take, for example, the case of medical cannabis. The effects of a dose of cannabis on a particular individual will vary, depending on

  • Characteristics of the individual, such as genetics, metabolism, and age
  • Characteristics of the individual’s history with cannabis, such as history of use and tolerance
  • Characteristics of the particular sample of cannabis consumed, including
    • Origin of sample: whole plant extract, isolate, synthesized compound, etc.
    • Form of use: flower, tincture, edible, etc.
    • Profile of contents in sample: profile of cannabinoids, ratio of cannabinoids, profile of terpenes, etc.
    • Size of dose: 5 mg, 25 mg, etc.
  • Setting in which the cannabis was consumed: isolated in a sterile lab room, relaxing with others in a comfortable room, etc.

In any RCT, the form, profile, and dose of cannabis is generally standardized across patients. It follows from the bullet points above that the effects of that standardized dose will vary widely across different users. So then it’s quite possible that the standardized dosing will not correspond to the dosing specifications that would be effective for different patient populations. As such, RCTs could easily suggest that cannabis was effective, if the form, dose, and setting matched those appropriate for the group of patients studied. On the other hand, the very same RCT could easily suggest just the opposite. The study could very well determine that cannabis is not helpful for the patients studied, if the form, dose, or setting used were not appropriate for the particular group of patients examined.

One can probably find flaws in just about any study. Of course, having a flaw doesn’t necessarily invalidate a study. However, we must take study findings in their proper perspective. We cannot simply accept the findings of any RCT because it’s the gold standard or reject the findings of another study for not being an RCT. Medicine is not about “hard science.” It’s about people. People are complex. They don’t fit nicely into well-defined boxes.

Yes, studies can provide us with information. However, we shouldn’t depend solely on studies to find “the truth,” that is, what’s best in a particular situation or for a particular patient. Rather, we should depend on experts – such as doctors – to do what they have been trained to do: rely on knowledge, skills, and experience to deliver personalized medicine, to help patients find the best treatments that meet their particular needs.

More Blogs

Why Is Alcohol Accepted While Cannabis Is Not?

24-11-2019 - Hits:192 - Ruth Fisher - avatar Ruth Fisher

Alcohol Use In America Cannabis Use In America Prevalence and Social Attitudes What Determines an Activity’s Prevalence? Social Attitudes and Laws Social Acceptance: Alcohol vs. Cannabis Social Narratives vs. Reality The Role of Common Knowledge   Both alcohol and cannabis have been around for thousands of years, and both have been used for recreational, spiritual, and medical purposes. Both...

Read more

Social Development Requires More Than Just New Technology

14-10-2019 - Hits:421 - Ruth Fisher - avatar Ruth Fisher

This post continues the discussion about what society needs in addition to technology to develop. In my previous entry, The Growth and Development Paradox, I established that Technology enables societies to develop. Foundational technologies have existed for thousands of years. Yet, sustainable development didn’t occur until the Industrial Revolution. Technological development is thus not...

Read more

Cannabis Science and Technology Finally Got Hitched!

03-10-2019 - Hits:400 - Ruth Fisher - avatar Ruth Fisher

The Separate Worlds of Science and Technology Throughout most of human history, science and technology existed within completely separate realms of society. Science, or natural philosophy, fell within the realm of the upper ranks of society. Natural philosophers were “uncommitted to any program of useful knowledge,” developing “abstract speculations about the...

Read more

The Growth and Development Paradox

24-09-2019 - Hits:569 - Ruth Fisher - avatar Ruth Fisher

Wheat yields in the UK hovered around ½ tonne per hectare for hundreds of years (see Figure 1). Imagine being able to generate no more wheat per unit of land than your ancestors who had lived 100 generations before you had been able to grow! The introduction of crop rotation...

Read more

The Four Social Forces That Shape Our Actions

23-09-2019 - Hits:534 - Ruth Fisher - avatar Ruth Fisher

Our desire to fulfill our wants and needs motivates us to act. A lot has been written about what, exactly, constitute our wants and needs as human beings. Examples include: Food, clothing and shelter Health, safety, and protection Self-preservation, sex, and procreation Social status, competition, acquisition, rivalry, power Love, belonging, connection Self-expression, creativity, contribution, independence I tend to...

Read more

What Promotes Social Well-Being?

22-09-2019 - Hits:394 - Ruth Fisher - avatar Ruth Fisher

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was...

Read more

Hurdles to Mainstream Adoption of Medical Cannabis

21-09-2019 - Hits:190 - Ruth Fisher - avatar Ruth Fisher

Based on the incentives facing different players in the US medical cannabis market, I believe the market will not achieve mainstream adoption unless or until the US overcomes several hurdles: (i) the classification of cannabis as a Schedule I drug, (ii) cannabis’s lack of FDA approval, (iii) the lack of...

Read more

Attracting Mainstream Consumers to Medical Cannabis

19-09-2019 - Hits:205 - Ruth Fisher - avatar Ruth Fisher

The US medical cannabis market is currently in its early stages of adoption: the market has gained some penetration, but not enough to warrant adoption by the early majority, that is, more mainstream users. My book, Winning the Hardware-Software Game, describes the technology adoption lifecycle in detail. A brief summary...

Read more