Problem-Solving and Paradigm Change
In About Non Zero Ratio you could read how, in order to achieve the Non Zero Ratio mission, cases will be developed and demonstrated that propose a new perspective that is considered impossible by all yet true, in the same way that in the past the earth was proposed to be spherical while everybody thought it was flat, or the earth evolved around the sun rather than sun and planets evolving around the earth etc.
Basically very tough problems appear to be solved by introducing a new perspective that was before considered impossible to be true. This hints a link between the solving of very tough problems and the need to find a new apparently impossible perspective that will turn out to be true.
The basic view behind Non Zero Ratio about problem-solving is that breakthrough insights:
- Originated initially with a single person that found a thinking error
- And next had very hard times to convince the world yet succeeded
Such breakthtrough insights are frequently referred to as paradigm changes : they cannot be true, yet turn out to be true from a new and in hindsight more correct perspective.
Non Zero Ratio holds the view that, because of the group think phenomena, it is much more difficult today than in the past, to introduce a new "impossible" perspective despite it being correct, despite the fact that there is now vastly more knowledge and many more knowledgeable people. Impossible perspectives appear to be crazy when they are aired, whether they are correct or not. The challenge thus is to be able to distinguish the crackpot perspectives ("it is not true that we landed on the moon") from the truly more correct impossible perspectives ("time runs slower close to earth" as shown by Einsteins theory of general relativity).
As Arthur Schopenhauer (1788-1860) said : All truth passes through three stages: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.
The truth in this statement was well-documented in Thomas Kuhn's The Structure of Scientific Revolutions (1962).
The Non Zero Ratio processes focus on the true nature of any major progress: paradigm changes.
The Non Zero Ratio processes
Non Zero Ratio is thus about the development and demonstration of processes that :
- Facilitate the detection and generation of such truly new perspectives, by overcoming thinking errors
- Facilitate the introduction of such correct new perspectives from an individual into society
The Need for a Demonstration Case
To succeed in the Non Zero Ratio mission, which is to demonstrate the existence of facilitating problem-solving processes, it is required to
- Construct a new perspective that is considered impossible and incorrect yet true
- Succeed to make this perspective accepted so it becomes the mainstream perspective
This page proposes a case that resulted from the Non Zero Ratio processes, consisting of a new perspective that is logically more complete and compellingly more correct than the current mainstream scientific view. It was already developed in 2002, and is used to further develop and optimize the still incomplete process of facilitating and speeding up the introduction of paradigm-changing perspective from an individual into the society. Associated White Papers were shared in 2007 with the Think Tank The Next Generation, in 2008 with Francis Heylighen' ECCO and on this website on June 12th 2014, updated February 26th 2015 and Sept 4th 2017.
Be warned: as Einstein said: problems cannot be solved at the level they were created: they require a paradigm shift.
A paradigm shift proposes by definition a deviation from the norm and is thus abnormal. So what follows will look absurd : a statement will be made that surely cannot be true. However, using a combination of known facts, a new logic will be presented that supports the absurd statement, and thus should be true also.
So here you go : how do you feel about the following suggested paradigm change:
Preventive health care campaigns against smoking, cholesterol, high blood pressure, obesity, ... that stress the harm may well increase risk and cause additional victims contrary to the general expectation!
This apparent absurdity is claimed to be true because of the placebo effect :
When new drugs are introduced by pharmaceutical companies, these have to comply with a legal framework to ensure that these drugs are working better than the placebo-effect, by successfully passing double blind clinical trials. This placebo effect is understood to be associated with expectation and conditioning. The placebo effect is mostly known for its curing ability in case of positive expectations. Yet it also manifests in case of negative expectations leading to harm and illness, in which cases it is frequently referred to as the nocebo effect. Scientists consider that placebo and nocebo are both manifestations triggered by expectation/conditioning. The nocebo effect however cannot be studied directly because of ethics : one is not allowed to intentionally harm. Yet, the nocebo phenonemon that negative expectations generate harm is well accepted within the medical community, with many studies demonstrating its existence and relevance.
The current normative thinking by the medical community is that the placebo effect does not have any effect on the effectiveness of preventive health care campaigns.
The Non Zero Ratio processes on the contrary lead to the thinking that the placebo-effect should on the contrary be expected to potentially have a major impact on the effectiveness of preventive health care campaigns.
The reasoning along the Non Zero Ratio process goes as follows:
- Most health care campaigns focus on the negative effects resulting from bad habits, to try to convince people to abandon these bad habits. A clear case is the anti-smoking campaigns that emphasize the negative "deadly" risks associated with smoking (getting lung cancer etc).
- In the minds of the people with these bad habits, this reinforces the negative expectation that, if they continue the bad acting (smoking), the bad consequences will result.
- This is exactly what the placebo effect, or more specifically the nocebo effect, is about : when the patient does an act (take a pill), and the expert environment reinforces the expectation you will get better, some patients actually get better even if the substance of the act (pill) is inert (placebo). Replace pill with cigarette and better with ill, and this leads to: when the patient does an act (take a cigarette), and the expert environment reinforces the expectation you will get ill, some patients actually get ill even if the substance of the act (cigarette) is inert (placebo).
So the Non Zero Ratio process leads to thinking that it is possible and actually likely that the placebo effect deteriorates the effectiveness of preventive health care campaigns as their effectiveness would thus be the result of two different effects:
- If in the example as a result a percentage of people would stop smoking, the risk of people getting cancer would reduce, which is the key reason for these campaigns.
- However, if there would be a placebo effect associated with the negative expectation, this would imply that in the example, for those smokers that do not quit smoking, the risk to get ill has been increased, in the same way that a patient that takes a placebo pill and expects to get better, sometimes indeed gets better.
- More surprisingly, especially if you are a non-smoker that sometimes wanders in smokey environments , you should also expect a nocebo effect because of the reinforced communication also passive smoking kills : the perspective presented here makes verifiable new predictions, see the White Paper in the Download section.
So the insight resulting from this thinking process raises following two research questions:
- Is one indeed disregarding the possible role of the placebo-effect in preventive health care campaigns?
- If so, is one justified to do so?
1) Is one disregarding the possible role of placebo-effect in preventive health care campaigns?
In medical research, one is not considering at all it is possible that the placebo-effect plays a role in preventive health care campaigns: The placebo-effect is never mentioned in research on the effectiveness of health care campaigns, as if it were considered, it should be clearly mentioned:
- If the possibility of the placebo-effect would be considered, one would start with trying to establish preventive health care campaigns by avoiding the mentioning of negative expectations (risks of lung cancer, being out-of-breath, ...), but rather focus on the positive effects (better sports results etc). This debate is nowhere being considered, reflecting the conviction that stressing negative expectations does not possibly have any negative impact on public health.
- Next, only if the mentioning of negative expectations cannot be avoided in the preventive health care campaign, one would thus assess the net result of both effects (i.e. what is the risk reduction due to people stopping smoking due to the campaign versus risk increase due to the negative expectation put into the minds of the smokers that cannot stop smoking through the placebo-effect), as this balance should be positive. This balance is completely absent in all research about effectiveness of preventive health care campaigns. And it also follows that there will be an increase in victims if the campaign does not lead to a reduction in size of the group at risk. That is actually the case for smoking campaigns in many Western countries, and especially for campaigns against obesity: the size of this group at risk simply increasing.
2) Is one justified to disregard the possible role of the placebo-effect in preventive health care campaigns?
This is an example of an error of omission, similar to Wason's four card problem. The scientific community does not feel the need to justify why the placebo-effect (in this case the nocebo effect) can be disregarded: preventive health care campaigns are expected to work as a norm. When you would confront a medical professional with the above lack of proof, you will likely be suggested that it is up to you to prove this far-fetched idea that the placebo-effect is indeed playing a role in preventive health care campaigns. This is not scientifically justified for the following reasons:
- As it is a reasonable assumption that the placebo (nocebo) effect can play a key role in preventive health care campaigns, the generally adopted precautionary principle in medical care is actually violated: It can deteriorate the campaign effectiveness, possibly leading, in worst cases, to highly increased risk: what if smoking campaigns do not succeed at recucing the number of smokers (currently the case in many European countries), and thus they essentially only reinforce the negative placebo effect...
- Medical experts should thus be able to justify why the placebo effect can be disregarded in the case of preventive healthy care campaigns, especially as from the current understanding of the placebo-effect, one should expect it to play a role by default. Yet, they don't provide this justification.
So the precautionary principle in combination with the reasonable logic (placebo = expectation; campaigns reinforce negative expectation) is sufficient to require justification from the scientific community.
Health care policy makers, unlike scientists, are in charge about public health. Thus, they need to apply the precautionary principle. When learning about the here presented perspective, they should thus request justification from the scientific community about the disregarding of the nocebo effect in preventive health care campaigns.
The scientific community has the obligation to justify this to health care policy makers.
To put pressure on the medical community, health policy makers should ask confirmation from cognitive psychologists that the reasoning disregarding the nocebo effect has a number of cognitive bias errors that need to be corrected.
If the scientific community cannot justify why the placebo effect can be disregarded in preventive health care campaigns (and from above it appears that this indeed will be the case), the precautionary principle should be expected to drive health care policy makers to forbid the use of negative expectations in preventive health care campaigns with legal means the same way double blind clinical trials are imposed on pharmaceutical companies in the case of new drug development.
The Non Zero Ratio process helps to understand why this thinking flaw was sustainable:
First reason: error of omission : this is a classic thinking flaw: one is not taking into account (= omitting) a known fact in the reasoning, without providing justification. In this case one omits the existence of the nocebo effect without justification.
Second reason : the aversity of scientists against belief: the placebo effect indicates that expectation works. As most scientists are non-believers it is plausible that they don't consider it worthwhile to investigate why and how expectation could work.
Third reason: Groupthink: There is an anti-religion attitude within the scientific community (the debate of science versus religion, "the God Delusion" cfr Richard Dawkins). This creates the conditions outlined by Irving Janis on when Groupthink is likely to occur : Groupthink bias takes place and reinforces the blindness against the role of the nocebo effect in preventive health care campaigns. From this perspective, the placebo-effect may be a Trojan Horse within science : though there is a long-recognized indication within science that expectation under certain conditions really works, scientists show a blindness to study how this works. This blindness may be caused by a lack of scientific rigor because of the mainstream bias against religion.
Fourth reason: Fundamental Attribution Error : If in double blind clinical drug trials, the drug demonstrates a positive clinical effect in 40% of the cases while the control group (placebo) demonstrates a positive clinical effect in 30% of the cases, the conclusion generally is that the drug works better than the placebo effect. In reality though, the placebo-effect is present in both groups, so the drug group is the sum of placebo effect and the drug (chemical) effect, and the drug only adds 10% to the 30%, so is contributing only 1/3 of improvement, and one cannot state that the drug works better than the placebo-effect. So in general, the effect in the drug group is considered to be fully attributed to the drug and is considered to be the most important effect even when it is hardly better than the result in the control group. In conclusion, one considers that the chemical component is the dominant one, and minimizes the role of expectation
Fabrizio Benedetti developed alternative clinical trial set-ups with hidden administration of drugs to eliminate the role of expectation (see e.g. his book The Patient's Brain: The Neuroscience Behind the Doctor-Patient Relationship, Oxford University Press, 2010), and found that in those cases, when eliminating the expectation, the resulting drug did indeed work far less than previously expected, concluding that the communication factor (the expectation created by the doctor) is much more important than currently considered.
The bottom line here is that when interpreting the results of clinical trials, scientists appear to attribute (in their language) the "chemical" working principle to the full effect (in the example 40%), while in reality in many cases an important contribution is actually caused by different effects that are also in the control group (placebo effect, natural curing, ...). In cognitive psychology this error is referred to fundamental attribution error.
More recently, this downplaying of the placebo effect due to the fundamental attribution error was also demonstrated when a European report stated "homeopathy has no proven effect on health care as it is no better than placebo". This makes again the fundamental attribution error : the placebo effect is known to effect health so if homeopathy is equal to placebo, homeopathy also affects health. Further more, as Richard Dawkins willingly acknowledges, homeopaths in average spend much more time with their patients than traditional doctors. Hence, because of the proportionality of the placebo effect with communication and trust (see also Benedetti's The Patient's Brain), one should expect that the placebo effect in homeopathy will in average be stronger than the placebo effect observed in double blind clinical trials, especially as in the latter, pharmaceutical companies, because of a conflict of interest, likely consider the placebo-effect to be a disturbing phenonemon that should be minimized as much as possible through design protocols so as to allow for the chemical factor to be more dominant. Hence, it is reasonably possible that a homeopathic treatment will be more efficient than the treatment with a classic drug, even if the homeopathic treatment is no better than the placebo effect if the homeopathic treatment has a stronger placebo component than the classic drug because of a higher-quality patient-healer relation (cfr Fabrizio Benedetti).
This downplaying of placebo results in most research being oriented towards the adequacy of drugs and their development (the chemical component, where the money is), and in comparison ample research towards understanding the placebo effect as an all-round healing mechanism that deserves to be better understood.
Fifth reason: loss-aversion bias and action bias : The possibility that preventive health care campaigns may have averse health effects because of nocebo brings up the question how to improve health care without pointing out the negative consequences of bad behavior. As there is no clear alternative to improve health care, loss-aversion bias and action bias reinforce the anchoring to the current fear-based health care campaigns.
It may be clear that the paradigm change proposed above leads to completely different (new) ways of:
- Defining health care campaigns (these should avoid stressing negative expectations of bad habits)
- Research towards improved drugs (much more focus on understanding and reinforcing the placebo effect)
- Testing of new drugs (focus on combining the chemical and placebo factor rather than viewing the placebo factor as an annoyance)
It may also be clear from the above that, if health policy makers request feedback from the medical community about the justification for disregarding the placebo-effect in preventive health care campaigns, they are not likely to get a response. The only response I received from all medical professionals is "this sounds indeed reasonable, I had not looked at it that way, but it is not my area of research".
Health policy makers will thus require, as suggested above, to consult with cognitive psychologists, the like of Nobel Laureate Daniel Kahneman, to confront the medical community with their thinking errors and thus push the community (that has no hierarchy so can easily hide otherwise) to take a position.
Non Zero Ratio envisages to more deeply understand this type of influencing and reasoning to facilitate in future the introduction of reasonably more correct perspectives that go against mainstream views: this is a key process in mastering fundamental problem-solving.
More information about this view:
(2015, English) White Paper (292 kB pdf), an example of a paradigm change developed using the Non Zero Ratio process