EBM and CQI Article of the Week 4.19.2021

Know – Part 3

Can a process/event/statement be true and not true?

I had a college dormitory roommate who resembled the lead singer of the Rolling Stones.  It was remarkable.  Naturally, he employed his good fortune to amusing effects.

For example, if anyone at university would scoff he would casually comment “That’s me helping Carly with ‘You’re So Vain’.”  Rather brilliant piece of subterfuge, him blending feigned familiarity with another rock star and her monster hit, with casual “insight” into the then-mysterious urban legend (Is that Mick singing back-up?).  No Google fact-checking in the 70’s.

In essence, he unwittingly played on one of Eric Hoffer’s many unsurpassed observations re: mass movements and ideologues,…..Just remain vague enough to not be completely understood, because people tend to be certain only about things they don’t fully comprehend.   

If you have not read his classic – True Believer – well, you’re in for brain-delight.  His noble, heroic personal journey makes his writings indelible and authentic.  “When people are bored, it’s usually with themselves,…….The greatest weariness comes from work not done,…….You can never get enough of what you don’t need to make you happy,……..Propaganda serves more to justify ourselves than to convince others,……….The beginning of thought is disagreement, not only with others but also with ourselves”,……among hundreds of other musings about the nature of truth and knowing related to idealogues.

Variation in care processes and outcomes is the defining characteristic of the Vermont Oxford Network, nowhere more evident than NICU length of stay – the principle driver of resource utilization in neonatology.  LOS has been increasing for years,….how and why?.  It’s beyond noteworthy, and it largely resists current explanations.  Drs. Edwards, Horbar, et al have written a clear expository, and Drs. Arnold and Davis have added an insightful commentary (attached).  

Consider Ludwig Wittgenstein’s engaging “family resemblance” theory of knowledge and language games (he drew inspiration from Plutarch) – Things [NICUs] thought to be linked by a given feature [increasing LOS] do not share one principle similarity, rather, they overlap with several in variant fashion.  Just look at a large family of siblings and the two parents – you can see the overall resemblance, but no single shared feature for all.

Joe Kaempf, MD

District 8 Oregon Representative

Portland, OR

Volume 13, Number 13

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