# Can Our Brains Handle the Information Age?

Bret S. Stetka, MD; Daniel Levitin, PhD

Disclosures

September 24, 2014

### Clinician Takeaways

Medscape: What other information in your book might be useful for clinicians?

Dr Levitin: I have been teaching medical students for 15 years, so I know what their training involves. In my experience, most doctors are not trained in the same way as science graduate students in terms of advanced statistical modeling. I am not faulting the doctors, but I think medical schools need to be teaching Bayesian inferencing, for one, to improve estimates of something based on new information. It is something anybody can learn in an afternoon.

In a medical situation, an example would be a patient showing up with a blue face and the doctor trying to figure out if they have the "blue face disease" or not. Maybe the blue face disease only occurs in one out of a million people who present themselves to a doctor, and there are other causes of having a blue face like having stuck your head in a bowl of blueberries or lack of oxygenation. There are multiple potential causes, so you don't want to jump to conclusions. You want to think about the rarity of the disease, right? Doctors do this intuitively, but they don't always work it out mathematically because they haven't been given the tools. This is where Bayesian modeling could be useful.

Here's another example: Suppose you bump into somebody at your local Starbucks, and without looking at them I ask you what the odds are that the person you bumped into is the Queen of England?

Medscape: I would say next to zero.

Dr Levitin: Right. Now, I say, oh, by the way, the Queen of England is visiting your town today. What are the odds that the person you bumped into is the Queen of England?

Medscape: Higher, maybe half a percent.

Dr Levitin: Right, you adjusted it based on new information, and with Bayesian inferencing, you could actually work this out in numbers. You might start with the population of your town during the day, the proportion of people who are in the Starbucks at any given time, and the likelihood that the Queen would go to a Starbucks—then you could come up with a reasonable numerical estimate.

Now, suppose I tell you the Queen of England is visiting Brooklyn and she has decided to visit your Starbucks and, in fact, they have closed it off. Nobody is allowed in it except her and her entourage, but you emerged from the bathroom unknowing that all of this was going on and you bump into somebody. Now what are the odds?

Medscape: It's either the Queen, a member of her entourage, or a Starbucks employee. The odds are much higher.

Dr Levitin: Exactly. This is the essence of Bayesian reasoning, and it has deep implications for medical decision-making. One other issue that could be relevant to clinicians is our tendency to fall into errors of reasoning. I'm not ragging on doctors here. Of course, medicine has had tremendous successes, and a number of diseases that were likely to kill a large proportion of the population have been entirely eradicated. Doctors have expertise that no one else has, and they are very good at what they do. But they are human.

Take cardiac bypass surgery. The last time I looked at the statistics, there were half a million performed in the United States every year. Now, what is the evidence that it is helpful? Randomized clinical trials show no survival benefit in most patients who have the surgery, but surgeons are thinking about the logic of the procedure as justification for it. You have a plugged vessel. You bypass the plug. You fix the problem. End of the story.

So if doctors think a treatment should work, they tend to think that it does work even when the clinical evidence isn't there. Angioplasty went from 0 to 100,000 procedures a year with no clinical trials. Like bypass surgery, the popularity was based simply on the logic of the procedure.

That said, I have been focusing here on high-profile cases like cardiac procedures and prescription drugs, but the fact is that if you have something wrong with you, you don't go running to a statistics book. You go to a doctor, and, you know, good doctors are really amazing at what they do.

Medscape: You also provide a number of tricks for working around memory deficiencies in your book—practical tips like leaving a strange object by the door so you are reminded to complete some task. Have you worked at incorporating these approaches into, say, dementia or Alzheimer disease management?

Dr Levitin: I haven't worked directly with this, but I believe that these are helpful for people with Alzheimer disease or other cognitive impairments. Externalizing is what it is about. Even if you don't have Alzheimer disease, having things like a pill dispenser with the days of the week and the times of day is very helpful. I talk about the neurologic reasons for this. Taking a pill is such a commonplace activity that unless you have the mind of a Zen master, in all likelihood you've forgotten the act five minutes after completing it. And this is worse in cases of dementia.

The reason you don't forget that you ate breakfast is that your homeostatic system is telling you that you are not hungry. But you've got no homeostasis for having taken most pills.

Medscape: What's next for you?

Dr Levitin: We are undertaking a number of studies in our lab and with our collaborators on trying to better understand this mind-wandering mode and its efficacy in creativity and productivity. We are looking at possibly doing developmental studies looking at how children develop, and by developmental I mean the way that the mind-wandering mode functions in people of different ages.

We are also looking at empathy in humans and mice—trying to understand the factors that increase empathy. And I haven't decided what my next book will be, but I'm writing all the time. I write every day.