Abstract
Making the transition from doing (wet) laboratory research to health services (dry lab) research required a different way of thinking. Simplifying the issues to create a model was one of the most difficult tasks I had to master in order to conduct good social research. There are many kinds of models – physical, mathematical, analogue, just to name a few. Models can represent a phenomenon or model data. Models may represent explicit underlying theories or incorporate frameworks. While the terms model, framework and theory are often used interchangeably, some make important distinctions. Models can be explanatory or predictive or both. This may be limited to some restricted domain. For example, Newtonian physics works fine except when dealing the subatomic realm or speeds that approach the speed of light. There are other criteria as well, e.g., refutability, cost, and elegance (simplicity and aesthetic appeal). However, in the end, models are only as good as they are useful. All models are simplifications of reality. It is impossible to look at everything, so some analytical reduction is necessary. However, to do this requires making the assumptions explicit, another difficult task. Our mental models are lenses in which we view the world, but they refract that world and focus on some aspects while ignoring others. Using models of complex systems has become essential in all aspects of an academic medical career – practice, research, teaching, and management.
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Notes
- 1.
Related quotations include: “Remember that all models are wrong; the practical question is how wrong do they have to be to not be useful. “In George E.P. Box and Norman R. Draper, Empirical Model-Building and Response Surfaces (1987), 74 and “…all models are approximations. Essentially, all models are wrong, but some are useful. However, the approximate nature of the model must always be borne in mind…” In George E.P. Box, Norman R. Draper, Response Surfaces, Mixtures, and Ridge Analyses (2nd ed. 2007), 414
- 2.
As a specialist in endocrinology, I am frequently asked by other physicians for advice about patient care, sometimes for a specific patient and sometimes for more general question. These informal consultations have been part of medical practice since time immemorial. Informal consultations are sometimes referred to as “curbside,” “hallway,” “elevator,” “sidewalk’” “parking lot,” “telephone” and I imagine “agora” and “stoa” consults. There are a number of issues that arise in informal consultation. For example, how accurate are they, given that the consultant neither sees the patient nor reviews the chart and is dependent on his colleague’s presentation of the case. Similarly, when the question seems more generic, does it apply to the particular patient the consultee has in mind. What is the impact of such consultations on patient outcomes, physician knowledge, and to what extent can it substitute for formal consultation.
- 3.
An illustration of this is in the “thumb pinning exercise” that I conduct during many of my lectures. I was taught this exercise by my colleague and collaborator Dr. Julie Johnson currently at Northwestern University. In this exercise two players face each other, hold out their right (or left) hands and clasp them with each player’s fingers curling around the other’s with thumbs extended upward. The object is to pin the opponents’ thumb. It has been called a thumb war, but goes by other names and is done in many countries. When I do the exercise, I avoid the term thumb war and simply demonstrate the hand position and state the object: pin your partner as many times as possible in 15 s. When I say go, the class usually erupts in hard combat with individuals trying desperately to avoid being pinned or trying hard to pin their opponents. When I call time, it usually takes a while for the class to come to order. I then ask them to count the total number of pins in their dyad (being an academic I avoid using a 5 dollar word when a 10 dollar word will do). Then I ask how many got zero pins. Some brave souls admit this. Then 1,2,3 and more people acknowledge this result. Then I ask how many got 20? Usually no one raises their hands. Then I take someone from the audience and demonstrate. We assume the position but I instruction my partner to leave her thumb down. Then I tap in 10 times or so in rapid succession and put my thumb down asking my partner to pin me which she does 10 times. We have achieved 20 pins in less than 10 s. Some in the class are looking sheepish, some dumbfounded, others confused. Then I point out that the instructions were to pin your partner as many times as possible in 15 s. I said nothing about not letting your partner pin you. Recognition dawns. Then I say not letting your partner pin you was an assumption of your mental model for the exercise. You brought it with you without necessarily realizing it.
- 4.
Realism in this context means that the world exists independent of our mind and any conceptual scheme that the mind create. The modesty comes from the view that what we believe now is an approximation of reality but that we can improve the accuracy.
- 5.
Elimination of factors considered unimportant or irrelevant and inclusion of false assumptions (deliberate distortions) have been referred to as Aristotelian and Galillean idealization, respectively. Stanford Encyclopedia of Philosophy. Models.
- 6.
Kitcher goes on to argue for an analogous thesis about the sciences in general, specificially that our ways of dividing up the world into things and kinds of things depend on our capacities and interests. Just as cartographical conventions and divisions evolve in response to changing human purposes, so does science. Moreover, since there no good reason to believe in the ideal atlas, but rather a compendium of maps for different purposes, he suggests that we abandon the idea that cartography is governed by a context-independent goal and further, that perhaps science is similar. This is only an argument by analogy, but it does raise the issue about whether there is a context-independent aim of science. He develops this line inquiry in this book and other works.
- 7.
Literary examples of this come from Lewis Carroll and Jorge Luis Borges. In Sylvie and Bruno Concluded (1893), 169, Lewis Carroll wrote:
“That’s another thing we’ve learned from your Nation,” said Mein Herr, “map-making. But we’ve carried it much further than you. What do you consider the largest map that would be really useful?”
“About six inches to the mile.”
“Only six inches!” exclaimed Mein Herr. “We very soon got to six yards to the mile. Then we tried a hundred yards to the mile. And then came the grandest idea of all! We actually made a map of the country, on the scale of a mile to the mile!”
“Have you used it much?” I enquired.
“It has never been spread out, yet,” said Mein Herr: “the farmers objected: they said it would cover the whole country, and shut out the sunlight! So we now use the country itself, as its own map, and I assure you it does nearly as well.”
Similarly, in On Exactitude in Science, Jorge Luis Borges, wrote: …In that Empire, the Art of Cartography attained such Perfection that the map of a single Province occupied the entirety of a City, and the map of the Empire, the entirety of a Province. In time, those Unconscionable Maps no longer satisfied, and the Cartographers Guilds struck a Map of the Empire whose size was that of the Empire, and which coincided point for point with it. The following Generations, who were not so fond of the Study of Cartography as their Forebears had been, saw that vast Map was Useless, and not without some Pitilessness was it, that they delivered it up to the Inclemencies of Sun and Winters. In the Deserts of the West, still today, there are Tattered Ruins of that Map, inhabited by Animals and Beggars; in all the Land there is no other Relic of the Disciplines of Geography. — Suarez Miranda,Viajes devarones prudentes, Libro IV, Cap. XLV, Lerida, 1658 (Collected Fictions, translated by Andrew Hurley).
- 8.
Albert Szent-Györgyi von Nagyrápolt, a Hungarian biochemist who won the Nobel Prize in Physiology or Medicine in 1937 for the discovery of vitamin C and the components and reactions of the citric acid cycle.
- 9.
In fact, the Ptolomeic model of an earth-centered universe served quite well for many years and with increasingly elaborate modifications made predictions better than some of the Copernicus sun-centered model until Kepler discovered that the orbits of the planets were elliptical rather than circular. It was Galileo’s telescopic identification of Jupiter’s moons that sealed the downfall of the earth-centered model and Kepler’s identification of elliptical rather than circular planetary orbits that made the heliocentric model more useful for prediction.
- 10.
Interestingly, the fox/hedgehog dichotomy as also been applied in the area of forecasting. PE Tetlock found that forecasters’ accuracy correlated with cognitive style; foxes were better forecasters than hedgehogs. (Tetlock PE. Expert Political Judgement. Princeton University Press. 2005, the front cover of which has pictures of a fox and a hedgehog.) Hal Finney created a quantitative scale to assess cognitive style. http://www.overcomingbias.com/2006/11/quiz_fox_or_hed.html
- 11.
The simplicity of design and the relative ease of making the components out of readily available materials made this form of radio receiver a favorite in foxholes where a razor blade served as the diode detector. In prisoner of war camps components could be made or scavenged, but were also smuggled into camp in cribbage boards in Red Cross Parcels. The components were small and didn’t interfere with playing cribbage. Occasionally more complicated designs were used. It is truly amazing to see limitless human ingenuity and to what one can learn with a little internet surfing. http://rageuniversity.com/PRISONESCAPE/RADIO%20AND%20TV/Foxhole%20Radios%20AND%20Crystal%20Radios.pdf (Accessed April 2, 2018)
Construction of Radio Equipment in a Japanese POW Camp. http://www.zerobeat.net/drakelist/powradio.html (Accessed April 2, 2018)
- 12.
While I felt I had an understanding of radios in the era of vacuum tubes, incomprehension accompanied the transition to solid state. Transistors left me somewhat flummoxed. I also missed the anticipation of a radio coming to life as the filaments of the vacuum tubes heated up and glowed.
- 13.
The Biochemical Pathways wall chart (first published in 1965) was originally developed by Dr. Gerhard Michal to show different biochemical processes occurring in living organisms. https://www.roche.com/dam/jcr:a8123664-2dac-4e4f-a744-0d847446f874/en/biochemical_pathways_factsheet_150514.pdf
- 14.
The rest of the quotation goes on to explain why he can’t understand electromagnetic theory.
- 15.
Potochnik identifies several motivations for idealization, some related to the nature of the world that is modeled (e.g., exceeding complex causal structure and computational limits) and some due primarily to the limits of scientists themselves (cognitive limits, limited research focus, and limits of computational power). She argues that Idealizations aid in presentation not simply by what they eliminate, such as noise or non-central influences, but in virtue of what they add, that is their positive representational content. She also makes an interesting argument that models are idealizations, that idealizations are rampant in science, and that not only can models be wrong and be useful, but that sometimes models known to be false are used because they are helpful.
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Aron, D.C. (2020). Models. In: Complex Systems in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-24593-1_2
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