I love me some magic!

There's an entertaining essay, Magic by Numbers, in today's New York Times. It's written by a psychologist who asks why we treat infections for durations of time that seem arbitrary (like 7 days). As an infectious diseases doctor, I must admit that duration of antibiotic therapy is one of the most common questions I am asked, and one for which there are few data. I sometimes preface my response to the how-long-to-treat question with, "I'm just making this up," and then pontificate with something like, "but I would treat for 10-14 days." And the intern dutifully enters an order for a 10-day course of vancomycin if the patient needs to stay in the hospital to receive it, or 14 days if the patient can receive IV antibiotics at home. The author of the essay, Daniel Gilbert, nails it when he writes that magic numbers "hold special significance for terrestrial mammals with hands and watches, but they mean nothing to streptococcus." Uh-oh! Our erudite approach has been exposed as nothing more than magical thinking. But there's a lot of magical thinking in medicine. Here are a few examples that come to mind: Wearing a white coat makes a doctor more professional. White coats worn daily for months without washing couldn't possibly be involved in transmitting bacteria to patients. The only way to control MRSA in the hospital is by culturing every patient for MRSA and isolating those that are colonized. And my current favorite: influenza vaccine is so effective that we should fire healthcare workers who don't get one (here's a new paper on that topic).


P.S. Here's a video of a great TED talk on impact bias and synthetic happiness by Dan Gilbert.