Confidence, competence, and why not to buy lottery tickets from MDs

The Secret of Confidence
Confidence is a word that is used in a variety of ways. Being confident is related to being assertive as well as being calmly alert (rather than pre-occupied or barely awake, etc). But what about the issue of actual competence?

The basic meaning of confidence that I use is the experience that comes first from being alert to the details of a situation, then recognizing the situation as something that you have already successfully handled, and finally a willingness to display (to assert, to demonstrate) your own perceived ability to being able to produce a particular result that you consider relevant/ favorable.

However, a momentary experience of confidence is not an actual guarantee of results. Confidence is just an experience associated with a reasonable and sincere expectation of the capacity to produce future results.

This definition of confidence is intentionally specific to a particular situation. “Confidence” as a general trait is often confused with boldness or even naivete. There is no authentic confidence except in regard to producing a specific result. In other words, there are no “confident people.” There are assertive people and courageous people, but people are confident relative to a specific issue or outcome.

Things like optimism or the absence of doubt are not the same as confidence. We can easily recognize when confidence is present or absent by the various reactions that someone may display if their alleged confidence is challenged.

Consider the example of asking an MD whether a particular drug is effective and relevant. If the MD sincerely believes that a drug is good for a specific case (and has no special concern or doubt about the issue), then they may display sincerity. But how would they display real confidence? We’ll come back to that.

First, here is an example of sincerity: “I have studied thousands of cases in which this method was successful. If you would like, I can share some research on the subject with you.”

Sincerity is not the same as accuracy or competence. A person can be sincere (honest) without being accurate (experienced).

Here is a simple display of confidence: “Would you like to review a few testimonials about cases very similar to yours in which I produced the results you value?” When there is a lot of confidence, the response can be very calm, concise, and specific.

How about this: “I have personally applied this method many times and with increasing success over time. I gradually refined my expertise. I learned how to modify the method, like how to tell when to slow down or speed up. I also have seen many cases that other practitioners did not address well and then I analyzed the cases and produced the desired results through refining the methods.”

Imagine someone who has a reputation within their industry for excellence (and who has endorsements from many other experts within the same specialty). Now, with a “leading expert” in mind, what would be the difference between confidence and arrogance?

Arrogance is actually a state of fear in which someone knows that they are not as competent as they are pretending to be. They may get defensive or antagonistic if their competence is challenged.

Someone confident is not especially interested in challenges to their competence. If challenged, they may offer some indications of competence, but also may feel no urgency to be validated by others. They may be more interested in why to invest time in to an interaction than in compulsively defending a reputation.

How about when a new concern is raised? Does someone confident belittle people for raising concerns (shaming them or guilt-tripping them)?

If an MD has been trained to give statin drugs in order to promote health in particular situations, they might not be interested in research on the effectiveness of statin drugs. They may be very confident about using the method (sincere). They may not be confident in the actual results, but they may be confident (sincere) in their presumption that the method will be beneficial to the patient.

They may also be very confident in their social position and their business. Again, that is distinct from confidence in medical results. They are just  not concerned about getting sued for fraudulently claiming that statin drugs are effective (or detrimental). They are relaxed and calm.

However, because of their training, they may have never actually been skeptical about the effectiveness of a particular treatment protocol. They may have never researched it. They learned someone’s else’s second-hand conclusion then repeated it back on a few tests, got a passing grade, and never considered the issue further.

They may have never scoured through the research looking for procedural flaws or holes in logic. They were not assigned to challenge the conventional presumptions so they may even sincerely think of the conventional speculations as accurate. They are confident in their textbooks and their training and their instructors, but that is not the same as being confident in the actual effectiveness of a treatment.

If they have never researched the effectiveness, they cannot be confident about it. They can be calmly presumptive though. They can be sincere.

They can be confident about using the method. They just cannot be confident in the results unless they have actually studied the measurable results produced in “scientifically-controlled,” clinical trials.

They do have a commercial interest in performing interventions that are profitable to them. Further, they have a vested interest in maintaining their perception that a profitable procedure is effective. They may be hesitant to review anything that brings skepticism or criticism. In other words, they may have an element of insecurity (fear).

What about the issue of injuries caused by a treatment protocol? If the MD has followed the rules of their insurance provider (for malpractice insurance etc), then they may have little or no interest in the actual research on risks. Their role is not to assess the risks of treatment methods. They pay an insurance company to handle that. They are just a technician trained in identifying certain issues and then more or less mechanically responding to their diagnosis with an approved treatment (approved by the insurance plan, by the state licensing board, etc).

Are there MDs who are more focused on research? Of course some are more focused on innovation than others. However, generally speaking, the researchers are not taking walk-in patients and billing insurance companies.

We can think of MDs in a more “libertarian” setting (without so much bureaucratic supervision). Maybe they are in a warzone or remote area where certain common medical supplies are simply not consistently available. They may be forced to innovate and experiment.

However, that is not the typical MD. Most MDs are just doing whatever they have been trained to do. They may measure progress in individual cases, but they are not analyzing their data and comparing it to “control groups.”

Lawyers and insurance companies understand that when MDs use a particular treatment method, there are financial interests in promoting profits. Lobbyists and PR companies can be hired to govern biases and create specific kinds of favoritism. Researchers can be hired with explicit or implicit bias toward particular kinds of results. If a particular study does not produce the desired results, another study can be conceived and funded (if the profits behind a particular method are sufficient).

In a legal case, a lawyer may not be interested in accuracy. They are simply promoting a particular financial interest. They are promoting a particular decision (and influencing the perceptions of the jury with a very specific bias in mind).

Which research gets funded? That is guided by commercial interests.

Which research gets mentioned in a congressional hearing or a court case? That depends on the interests (biases) involved.

Oddly enough, according to my first-hand research of US government documents (a report from the Department of Justice), there have been many huge awards in civil lawsuits  to people injured by vaccinations in the US. I have heard (without researching the details) that similar rewards have been made in Europe in court cases.

In other words, judges and/or juries assessed the facts of the cases and gave big rewards to the injured patients (or to surviving relatives). My research excludes any cases in which the defendants (such as insurance companies) “settled out of court.” In some cases, the injured party may even sign a non-disclosure agreement.

Generally speaking, most people trusted MDs who instructed them to receive vaccinations or take statin drugs etc. Because of the general public confidence that MDs are competent and honest and using methods with scientific merit, some patients would not even associate any negative experiences with the medical interventions.

In the case of statin medications, healthy people do not generally use them, right? So, any deterioration in health is likely to be identified as “in spite of the medical interventions” rather than “specifically the result of the medical interventions.” Of course, there are exceptions to that as well, such as in the case of certain cancer treatments regularly causing hair loss.

However, how many MDs can say “I know this method will benefit you and I know exactly how?” Yes, statin drugs produce a predictable biochemical effect (as distinct from placebos), but what defines a “benefit?”

Hypothetically, it is up to a patient to identify something as beneficial or not. Do they feel better? (So do many people who take placebos….) Can they measure significantly better performance in daily life? (Again, what about with placebos?)

My understanding of statin drugs is that they inhibit the liver’s ability to manufacture an essential nutrient. How did it ever seem attractive to inhibit the manufacture of an essential nutrient?

I do not know that it ever was medically attractive. What if a researcher determined that a particular drug had a particular result and then the marketing department was called in to figure out how they might be able to get people to pay far more for that product than it cost to manufacture it?

The head of the marketing department said “what if we create a hysteria and present this product as the solution? If statin drugs inhibit liver function, then what about liver function can we use to sell this medication to the public?”

How about this: the liver manufactures an important component of the immune system which the body then uses to combat certain health challenges. When particular kinds of health challenges are present, the liver raises production of that substance.

So, the presence of that substance is correlated with certain medical diagnosis. The marketers may have noticed all of this and then said “what if we demonize the substance as if it were a poison that CAUSES the medical ailments that it remedies?”

So, they funded some researchers to conclude that cholesterol causes certain problems. Maybe it was pseudo-scientific, fraudulent quackery from the start, but it was definitely good for business, right?

Later research shows that statin drugs still impair liver function (just as was established by the original trials). However, a “shocking” conclusion eventually came to the attention of some very disappointed patients: it is actually better to do nothing than to systematically impair the function of the liver.

So, the civil lawsuits may begin to flow a decade or two after the procedure has been effectively marketed to some group of consumers. The massive profits of the procedure can be used to fund lawyers and lobbyists to defend / protect the practice (even generating taxpayer-funded subsidies or mandates for compulsory participation).

What is the connection between statin drugs and vaccinations? I did not say that there was one. Frankly I am insulted that you would even imply that there could be any connection between MDs and convenience store clerks.

However, back to what I was saying before, wouldn’t it be awesome for business if, just for preventive precautions, everyone was compelled to take statin drugs just to make sure that their livers do not ever get “too active?” How many procedures should be compulsory? How much should the government force consumers to pay for these interventions?

Is it possible that the health of a particular individual is no major concern for any particular bureaucrat (or any particular MD)? Maybe there is an interest in promoting the health of certain specific individuals or groups. Maybe there is a willingness to risk the health of the certain individuals or groups.

What I find re-assuring is to keep in mind the existence of government-sponsored lotteries. Someone could win a prize of 66 million dollars this very week somewhere. Lots of people play the lottery, so it must be a good investment and you will probably win a grand prize eventually if you just keep playing long enough.

Note that the cashiers at the convenience stores care very much about the results of every individual participant in the gambling operation. In that regard, they are like MDs.

Most participants in the gambling operation will not get any benefit and are just paying for a bunch of bureaucrats to have jobs. Of course, someone gets a big prize occasionally too. Further, convenience store clerks probably get some benefit from the continuation of the system as well.

However, with a state lottery, you can only lose the amount of money that you invest in to buying lottery tickets. It’s not like buying tickets will impair your liver or something really major, right? Also, have you ever noticed that people who have been convenience store clerks for a few years eventually seem less and less enthusiastic about investing their own money in lottery tickets?

But as I was saying, vaccinations are very important, totally safe, and everyone should get vaccinated at least once a week, especially convenience store clerks and MDs (who frequently interact with the public). In fact, MDs should probably get vaccinated every day so that they do not infect their patients with any stray cholesterol.

Also, lawyers should get vaccinated twice a day (to help us be certain that there are no negative “side effects” to any vaccines). Keep in mind that when I say vaccines, I am implying that all vaccines are basically the same and no subcategorization is relevant.

As for confidence, people who make jokes may or may not be confident. Their jokes may be evasive distractions. Or, they may be pointing to something obvious but rarely addressed. Some things may just be too disturbing (to most people) to be addressed in any other way than through comedy.

That is why comedy should not exist, logically cannot exist, and therefore must be carefully prevented through the consistent use of statin medications. Plus, comedy must be immediately regulated, licensed, and criminalized because comic treasons and heresies could be a threat to the commercial success of certain business operations.

In conclusion, when I say to someone “how confident are you that the MD you have been seeing is competent,” they should display their calm confidence by raising their voice, displaying that they are offended, and then hysterically saying “you are not suggesting that I am disappointed by the recent results…. or in some way interested in social approval, are you? I certainly am not interested in approval (except in regard to validating my own patterns of activity in which I have the least confidence). Sure, I want constant re-assurance through my social network and TV ads and so on. But who doesn’t? You’re not saying that I am an outcast or reject, are you? Anyway, if you dare to question the logic of any of my actions, I may begin to suspect you of being interested in the actual results that I experience… and you best be careful of me perceiving you to be a threat to my chronic tensions of carefully-constructed pretenses and repression.”

That is why pace is important. It is important to be attentive to how motivated people are to developing clarity, competence, and confidence. If it is relevant to slow things down or speed things up, that is important to notice. Are they really interested in producing certain results or do they just value the social re-assurance that their favorite pretenses are working well enough to avoid punishment?

It is not good to be a convenience store clerk and give people prudent investment advice. They won’t buy any lottery tickets from you if you keep emphasizing the fact that the government operates the program so it therefore must be very good for all participants. They will probably just buy lottery tickets from some other store.

Likewise, if you want someone highly competent at promoting health, why would you automatically go to an MD? What clinical trials have you read that compare the results produced by MDs with competitors in other related fields?

If you use an MD, how do you select a specific MD? How much time do you put in to assessing their effectiveness against other MDs within the same specialty?

How motivated are you to assess the effectiveness of your most familiar ritual habits? How interested are you in results?

Do you want to be confident that your methods are very popular and will not lead to any social complications in regard to people questioning you (or harassing you) about why you are so much more interested in actual results (more interested than other people seem to be_? Or, do you prefer to be confident that the methods you are using reliably produce the results that you value most? Are you willing to assess the results of various methods in order to intelligently experiment with different variations so that you improve your results?

Are you willing to risk learning? Even at the risk of some of your most familiar presumptions being revised or corrected or discarded, are you willing to learn?

Why not just focus on being condescending toward other people who may be more interested in social validation than in other results? Why not shame them and harass them? Why not repulse them and distance yourself from their influence so that you can take a moment to relax, to calmly assess what you value most, and to measure the different results of different methods and then invest your time and resources accordingly?

Yes, there is a presumptive experience that is often called confidence (as in sincerity or naivete). Quite distinct from that is “real” confidence based on actual expertise or competence, such as confidence based on repeated trials with control groups, precise objective measurements, facing “constructive criticism,” and so on.


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