A conundrum of esoterica (2022)

Harry Cutter: Every great magic trick consists of three parts or acts. The first part is called "The Pledge". The magician shows you something ordinary: a deck of cards, a bird or a man. He shows you this object. Perhaps he asks you to inspect it to see if it is indeed real, unaltered, normal. But of course... it probably isn't. The second act is called "The Turn". The magician takes the ordinary something and makes it do something extraordinary. Now you're looking for the secret... but you won't find it, because of course you're not really looking. You don't really want to know. You want to be fooled. But you wouldn't clap yet. Because making something disappear isn't enough; you have to bring it back. That's why every magic trick has a third act, the hardest part, the part we call "The Prestige"."

While some may view exposure of illusions and magic maneuvers as educational opportunities others may think it ruins the experience. This is a practice that brings lots of criticism and may even result in ostracizing of the professional from the community. These consequences are not isolated to the magic profession, it also happens in medicine. A physician who has received lots of criticism for revealing problems with medical practice and scientific research is John Ioannidis. His articles which include Why most published research findings are false (2005, PMID: 16060722) and Why Most Clinical Research Is Not Useful (2016, PMID: 27328301) challenge current approaches to scientific research and medical practice. In 2016 article titled Evidence-Based medicine has been hijacked: a report to David Sackett (PMID: 26934549) he describes some of his current concerns. He writes,

When I published a story in the Christmas BMJ on how physicians are treated by the pharmaceutical industry with free lunch vacation with full entertainment in the Arabian peninsula[9], a powerful politically-connected syndicalist doctor in Athens wrote to the medical society asking for my exemplary punishment and revocation of my medical license. He also attacked me personally at the board of directors of the national disease control center where I was vice president. He entered one day the board room and said that he cannot co-exist with a person of such exceptionally low moral standards. No one defended me, but eventually he did not have his way. I feel sorry that he had to co-exist with such a horrible person like myself.

However, things got far worse when EBM became more successful and recognized in many places beyond Canada. The same people who were previously spitting when mentioning “EBM”, started using the very same term to buttress their eminence-based medicine claims to prestige. Several senior people started to ask me to work with them, hoping that they would publish papers in major journals. Saying “no” and trying to stick to high standards for my work bought me even more enemies, including leaders of academia, politics (of the entire corrupted range of left-to-right spectrum) and academic politics. Even the syndicalist who had once tried to annihilate me re-approached me: “John, we all know that you are the best scientist in the country. Why don’t we work together? You know how successful I am.” He presented a long list of his power attributes and connections. The catalogue was stunningly impressive. Then he added: “the only thing that I lack is major publications in top impact journals. So, here is what we will do: I will give you power and you will put my name in major evidence-based publications.”

I hate having power, so obviously I declined. I have always preferred to work with the young and the powerless. But this made even more powerful people even angrier with me. A senior professor of cardiology told a friend of mine that I should not be too outspoken, otherwise Albanian hit men may strangle me in my office. I replied that they should make sure to get correct instructions to my office – turn left when they come up the stairs. I would feel remorse, if the assassins entered the wrong office and strangled the wrong person.

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This type of aggressive behavior is not rare in the history of science where people have been ostracized, prosecuted, and burned at the stake for standing for truth and against dogmatic teachings. In the history of science knowledge acquisition and transparency have mostly been tightly controlled by a few as philosopher of science Janet D. Stemwedel explains,

One of the big ideas behind science is that careful observation of our world can bring us to knowledge about that world. This may seem really obvious, but it wasn't always so. Prior to the Renaissance, recognized routes to knowledge were few and far between: what was in sacred texts, or revealed by the deity (to the select few to whom the deity was revealing truths), or what was part of the stock of practical knowledge passed on by guilds (but only to other members of these guilds). If you couldn't get your hands on the sacred texts (and read them yourself), or have a revelation, or become a part of a guild, you had to depend on others for your knowledge.

The recognition that anyone with a reasonably well-functioning set of sense organs and with the capacity to reason could discover truths about the world -- cutting out the knowledge middleman, as it were -- was a radical, democratizing move.

Ioannidis' concerns remind us that some things about the social practice of knowledge acquisition and transparency have not changed. He also states that EBM as currently practiced is not what it was originally intended to be. The original goal of Evidence-Based medicine was to practice medicine under a scientific and skeptical attitude and de-emphasize the unsystematic approach to practice in order to improve care. Furthermore, Ioannidis adds that even re-training these days would have negative effects,

David, I was astonished by your sense of humility and self-knowledge when I heard that you decided to undergo residency training again to refresh your clinical skills when you were already a full professor. Several years ago, I decided not to practice medicine any longer. I might have caused more harm than good. I could not even think of remedying this by repeating training. Re-training on how medicine is practiced today might make me worse. In some settings, we are close or past the tipping point where medicine diminishes rather than improves well-being in our society. Some truly excellent and committed physicians certainly continue to make positive contributions to health, improve lives, and save lives. However, with 20% of GDP being spent on health and health care so inefficiently, with such limited evidence or with conflicted evidence, medicine and health care can become a major threat to health and well-being.

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In a new article, How to survive the medical misinformation mess (PMID: 28881000), Ioannidis et al address some problems under the current paradigm,

The Medical Misinformation Mess comprises four key problems:

  1. Much published medical research is not reliable or is of uncertain reliability,offers no benefit to patients, or is not useful to decision makers.
  2. Most healthcare professionals are not aware of this problem.
  3. Even if they are aware of this problem, most healthcare professionals lack theskills necessary to evaluate the reliability and usefulness of medical evidence.
  4. Patients and families frequently lack relevant, accurate medical evidence andskilled guidance at the time of medical decision-making.

If an unsystematic training and educational assessments do not address these problems and physicians are practicing medicine without this knowledge, the best conclusion we can deduce from Ioannidis et al.'s findings may be found in Shtulman new book,

This tendency to overrate our understanding of natural phenomena has been labeled the illusion of explanatory depth. It is the illusion that our explanatory knowledge, as grounded in intuitive theories, runs much deeper than it actually does. This illusion has been documented in people of varying ages, from four-year-olds to forty-year-olds, and with varying levels of education, from minimal exposure to science to graduate-level training in science. It has even been documented in people who have significant firsthand experience with the domain under consideration (e.g., cycling experts asked to explain the mechanics of a bicycle). As someone who holds a PhD in psychology, I qualify as an expert in the field, yet I fall prey to the illusion of explanatory depth every time I prepare a new lecture on a psychological topic. I start my preparation convinced I know enough about the topic to occupy a full hour’s worth of class but soon discover I know only enough to occupy five minutes’ worth. My first year of teaching was one long foray into the illusion of explanatory depth.

Researchers who have studied this illusion have determined that it’s not just a matter of general overconfidence, on par with overconfidence in our driving ability or our financial investments. It’s specific to complex causal systems—systems with multiple causal pathways, multiple levels of analysis, nonvisible mechanisms, and indeterminate end states. Consequently, the illusion does not pertain to forms of knowledge that lack such properties, like knowledge of procedures (e.g., how to bake chocolate chip cookies) or knowledge of narratives (e.g., the plot of Star Wars). If you think you can bake chocolate chip cookies or recount the plot of Star Wars, you probably can.

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Our knowledge of natural phenomena thus suffers on two fronts: from our limited ability to explain these phenomena (in accurate terms) and from our limited recognition of this limited ability. We are blind to our own blindness.

Answering assessment questions and giving explanations without having the necessary skills to assess the evidence and, furthermore, not being aware of problems with the evidence itself is making up stories that suffer from the illusion of explanatory depth. Explanations are evidence of our knowledge, Daniel Kahneman was asked about the concept of knowing,

Kahneman has now retired from academia but remains in demand as a consultant, advising large firms on decision-making. He is currently fascinated by this concept of “knowing”. “What does it mean to know something?” he asks, his eyes sparkling behind his glasses. “It has very little to do with actual evidence. It is usually when you have no alternative, when it is the only thing that comes to mind. This is especially true if it is anchored psychologically by the fact that other people you trust also believe in this thing. And it is only then that you invent reasons for it.”

Overconfidence and story cohesion do not necessarily correlate with validity of evidence, Kahneman adds,

The confidence people have in their beliefs is not a measure of the quality of evidence [but] of the coherence of the story that the mind has managed to construct. Quite often you can construct very good stories out of very little evidence. . . . People tend to have great belief, great faith in the stories that are based on very little evidence.

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Life for the physician is a conundrum as the evidence is imperfect, but so is storytelling, especially with no evidence.

Uncle Monty: I have a feeling there are many things that you're going to see that you've never heard of before. Life is a conundrum of esoterica.

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FAQs

What does the statement a conundrum of esoterica mean? ›

I've titled this section Gender is a Conundrum of Esoterica, because it means that gender is something confusing or befuddling, something that is made up of complex parts that we do not or can not fully understand.

Who said life is a conundrum of esoterica? ›

Quote by Lemony Snicket: “Life is a conundrum of esoterica.”

What is an example of a conundrum? ›

a.

The conundrum takes place when the actual question is difficult to answer. For example, whether or not you should lie about cheating on your spouse is not a moral conundrum; but whether or not you should lie so that your spouse feels better about the way he looks might be a moral conundrum.

What is another word for a conundrum? ›

In this page you can discover 14 synonyms, antonyms, idiomatic expressions, and related words for conundrum, like: puzzle, paradox, quandary, perplexity, mystery, enigma, poser, dilemma, show, question and riddle.

Who said life without purpose is meaningless? ›

The 19th-century philosopher Friedrich Nietzsche, for example, said the question itself was meaningless because in the midst of living, we're in no position to discern whether our lives matter, and stepping outside of the process of existence to answer is impossible.

Is a riddle conundrum? ›

The tricky word conundrum is used to describe a riddle or puzzle, sometimes including a play on words or pun. One of the most famous conundrums is the riddle of the Sphinx, famously in the play Oedipus the King by Sophocles.

Why is it called conundrum? ›

The truth is more likely “origin never exactly known.” The most reasonable theory is that “conundrum” originated as a joke among university students in 16th century England, probably concocted as a pseudo-Latin nonsense word and initially used as a derogatory term for a fussy, pedantic and silly person (what the Oxford ...

What is the opposite of a conundrum? ›

What is the opposite of conundrum?
consistencycongruity
faithfulnessreliability
uniformitydependability
steadinessconstancy

How do you make a conundrum? ›

In order to make an effective argument, you need to raise a good question – one that might be answered in multiple ways. Otherwise, your conclusions are obvious from the start and there's no need to make an argument at all! A conundrum, by definition, is difficult to solve and might be solved in multiple ways.

What language is conundrum? ›

Surely the correct plural of 'conundrum' is 'conundra', given its Latin origin.

What is a double conundrum? ›

Double Conundrum takes you on a journey across multiple continents as tight plot lines unfold and then converge as the heroes try to uncover a devastating plan of destruction before it's too late. Great character development pulls you in, adding layers of depth. A must read from a promising new author. Report.

What is the difference between conundrum and enigma? ›

A conundrum is like a puzzle, or a riddle, or a problem ~ which needs to be solved, or is at least solvable. An enigma, however, is more of a mystery or mysterious phenomenon, which may or may not be solvable.

What's definition of esoterica? ›

Definition of esoterica

plural noun. things understood by or meant for a select few; recondite matters or items.

How do you use the word esoterica in a sentence? ›

I have inherited her warmth towards esoterica; she had none for people, but she loved her dreadful facts. It was the sort of esoterica I had never had an interest in but which now composed a whole world.

What is Esoteria? ›

°Having to do with concepts that are highly theoretical and without obvious practical application. synonyms: arcane, recondite, cerebral, secretive.

What are three synonyms for esoteric? ›

Synonyms & Antonyms of esoteric
  • abstruse,
  • arcane,
  • deep,
  • hermetic.
  • (also hermetical),
  • profound,
  • recondite.

What is esoteric example? ›

very unusual and understood or liked by only a small number of people, especially those with special knowledge: He has an esoteric collection of old toys and games. disapproving or humorous She has a somewhat esoteric taste in clothes.

Who is an esoteric person? ›

The term esoteric has been adopted in the spiritual community in a more philosophical sense, it is used to describe a practice or a person who seemingly has a deep knowledge of the universe and the lessons within it and actively works to connect with those things.

Does esoteric mean secret? ›

esoteric, the quality of having an inner or secret meaning. This term and its correlative exoteric were first applied in the ancient Greek mysteries to those who were initiated (eso, “within”) and to those who were not (exo, “outside”), respectively.

What is esoteric literature? ›

Western esotericism, also known as esotericism, esoterism, and sometimes the Western mystery tradition, is a term scholars use to categorise a wide range of loosely related ideas and movements that developed within Western society.

Is Esotery a word? ›

The word esotery is typically used in discussion of mystical and occult topics, especially obscure writings about them. The word esotericism means the same thing but is more common.

How do you use achromatic in a sentence? ›

How to use Achromatic in a sentence. This was applied to an excellent achromatic telescope of 34 in. It will be seen, then, that the visual and photographic foci are now merged in one, and the image is practically as achromatic as that yielded by a reflector.

Is Nietzsche esoteric? ›

great writer; therefore, Nietzsche is an esoteric writer. Since Heidegger, Nietzsche's esotericism has mostly been taken for granted, to the extent that Nietzsche might call it a scholarly, if not philosophic, prejudice.

What does esoteric mean in philosophy? ›

In the Oxford English Dictionary, esoteric is defined as follows: Of philosophical doctrines, treatises, modes of speech, etc.: designed for, or appropriate to, an inner life of advanced or privileged disciples; communi- cated to, or intelligible by, the initiated exclusively.

What are esoteric subjects? ›

An esoteric subject is a subject that is known to a select group of people rather than the population at large.

What is an esoteric skill? ›

Esoteric Skill Enhancement is one of the available Engravings in Lost Ark. Esoteric Skill Enhancement allows players to increase the maximum number of Elemental Orbs, as well as the amount of damage Esoteric Skills inflict. This Engraving can be used by Wardancer Exclusive.

What is the best antonym for esoteric? ›

antonyms for esoteric
  • common.
  • familiar.
  • known.
  • obvious.
  • public.
  • unmysterious.

What is the difference between esoteric and exoteric? ›

Religious context

The term "exoteric" may also reflect the notion of a divine identity that is outside of, and different from, human identity, whereas the esoteric notion claims that the divine is to be discovered within the human identity.

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