Confirmation Bias and Your Assessment of the Covid-19 Pandemic.

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This pandemic has knocked us all for a loop. Most of us are scared, frustrated, angry, frightened, or some combination of the above. Also, many of us are certain of the correct thing to do next, and a few of us are certain it’s a conspiracy.

“What the human being is best at doing is interpreting all new information so that their prior conclusions remain intact.” -Warren Buffett

I’m an OB/Gyn here in Redding. I love my work. I am not a social scientist, or an economist, or a politician. I’m just a doctor. I’ve lived here since 2006 and I love our town. I post on Facebook mostly about my kids when they let me, and traveling with my wife.

During the shelter in place we all seem to have more time on our hands because thankfully we have not had a surge of COVID-19 patients needing to be hospitalized. I have followed with interest the various recommendations from the CDC, NIH, Federal and State Governments. The data initially was sparse, it’s getting better, but we certainly do not have a perfect picture of just how disruptive this virus is going to be locally and nationally in the near and not so near future.

Doctors Dan Erickson and Artin Massihi during a videotaped press conference that went viral, but has been since removed by YouTube. A copy of the video is available on a Bakersfield ABC news station website.  

Last week Dr. Dan Erickson and his business partner were interviewed about their urgent care practice down at the other end of our valley in Bakersfield. They spoke well, presented some personal data and then commented on how they felt the shelter in place should be lifted now, suggested doctors were being encouraged to inflate COVID diagnoses, and opined that the shelter in place order was hurting our immune systems.

I wouldn’t normally comment on such a topic but I reflected on what they said and how they said it and decided to put my two cents in. From my Facebook post:

“This physician may have some valid points about the data he has collected. But this is exactly the sort of reporting that I think makes so many of us confused. This physician leads with presenting personal data and then shifts to expounding on social issues and conspiracy. He’s credible as a physician but why should we be interested in his political beliefs? If he is truly interested in the data, then he should publish it and discuss the ramifications it may have on policy. There are many accelerated web-based platforms for peer review of data. His coupling of data he does not provide, with pronouncements about Dr. Fauci and conspiracy, should give us pause. To ask for more transparency from the CDC is one thing, but to suggest the CDC is conspiring against us is quite another.”

The subsequent back and forth of differing viewpoints on Facebook was interesting. I appreciated that for the most part folks who either agreed or disagreed with his viewpoint were able to have a reasoned dialog.

Subsequently, Dr. Erickson’s claims that the temporary shelter in place was hurting our immune systems, was a hot topic in social media. I took issue with that as there really isn’t any evidence to support that claim. Dr. Jennifer Kasten, MD, MSc(Oxon), MSc(London): a pathologist with degrees in infectious disease epidemiology, mathematical modeling of epidemics, and fieldwork in epidemic control, stated in response to Dr. Erickson’s claim, “The world is absolutely teeming with microbes. You’re coated in them, your house is coated in them, they enter your body with every breath you take and everything you eat. Your immune system is getting a perfectly adequate workout. You’re just restricting your exposure to a handful of things (respiratory pathogens) for a very short period of time”.

The subsequent social media discussion started to become much more divided.

Then finally, his own medical specialty board felt that his actions were unacceptable and decided to “emphatically condemn the recent opinions released by Dr. Daniel Erickson and Dr. Artin Massihi”.

It is very uncommon for a medical specialty board to do this in such a public manner. It happens only in the most egregious of circumstances. Interestingly, most people either felt that either the board’s condemnation refuted his claims or actually bolstered its veracity.

“The eye sees only what the mind is prepared to comprehend.” – Robertson Davies

This phenomenon is referred to as confirmation bias. Most of us are guilty of it. We crave cognitive consistency. There is so much information out there. It is so much easier to have a shortcut. Once you have made up your mind about a certain topic, you look for ways to confirm it, even if there is significant data to the contrary. I’ve certainly been guilty of it as a doctor. I was trained by professors who I hold in high esteem. As the medical field advances, newer studies can refute long-standing practices or therapies. I don’t want to believe them because that is not what I was taught by my mentors. I would argue that I need to be open to new, cognitively dissonant ideas, if I want to be the best physician that I can be. But it is difficult.

Trying to find an unbiased source of information about the COVID-19 pandemic feels immensely difficult. Some people now claim it’s impossible with mainstream and social media. I believe the data and testing is coming that can help guide us. It’s taking longer than any of us like. I want to go to our small businesses again. They are suffering mightily. As we start to reopen our town I would advocate for a reasoned approach that does not increase the risk of unnecessarily overburdening our hospitals. Together, with an open mind, and an appreciation of confirmation bias, I think we can do great things safely.

Dr. Samuel Van Kirk
Samuel Van Kirk, M.D. OBGYN is a board-certified physician with nearly two decades of experience. He proudly provides compassionate, personalized care for women of all ages at his private practice in Redding, California. Dr. Van Kirk studied mechanical engineering and achieved his undergraduate degree at the University of California, Santa Barbara before receiving his graduate degree at Stanford University. After studying mechanical engineering, Dr. Van Kirk earned his medical degree from the Keck School of Medicine at the University of Southern California in Los Angeles. He then completed his residency in obstetrics and gynecology at the Oregon Health & Science University in Portland, Oregon. Dr. Van Kirk grew up in Colorado and enjoys an active lifestyle, including backpacking and spending time outdoors.
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23 Responses

  1. Avatar christian gardinier says:

    Dr. Van Kirk, personally, I’ll trust Doctor Anthony Fauci at this point. I think there needs to be a Congressional investigation on this Covid 19 mess, once we get through it as it seems like a catastrophic failure on tRump and his administration’s part. Nothing against Bakersfield but both Dr. Daniel Erickson and Dr. Artin Massihi have been documented as avid tRump supporters, clearly their presentation has been debunked by peers as bunk and biased.

    • Steve Towers Steve Towers says:

      I trust Dr. Fauci because he’s earned it, not because of his position. In general, I reserve some doubt regarding top-tier career bureaucrats. They’re constantly weighing their objective analyses against what their political bosses will tolerate, and the outcome of that balancing act does’t always land a recommendation in the right place. On top of that, you can see Drs. Fauci and Birx struggling with the additional burden of trying not to offend our thin-skinned, know-it-all Pumpkinführer. I don’t know how they deal with the strain of having to tamp down the endless issuing of blatant idiocies. I’d last maybe a week before this happened: “What the President just said is not only wrong, but reckless and stupid.”

      I trust tenured doctors and scientists at research hospitals and universities, high-level career bureaucrat-scientists, and Big Pharma scientists, in exactly that order. And there’s a big gap between #1 and #2.

      As for those two Bakersfield doctors….most M.D.s are practitioners. Methodologically, what they do is more akin to what auto mechanics do than the work of scientists. They consider symptoms, diagnose, and try to fix. I respect the degree, but unless your specialty is epidemiology, immunology, or virology, you probably shouldn’t be waving your M.D. around like it makes you an expert on managing a pandemic.

  2. Avatar Annelise says:

    THIS is what I’ve been circling in my mind but unable to articulate. Confirmation bias. Of course. Thank you.

  3. Steve Towers Steve Towers says:

    Thank you, Dr. Van Kirk. I’ve made no secret of my own biases: My daughter is a nurse practitioner and midwife at Kaiser Hospital in Roseville (BTW, she almost decided to attend Oregon Health & Science University, but opted for UC San Francisco). I’m pessimistic in some ways….I won’t be surprised if 70% or so of us get it in the long-run. But for her sake, I don’t want to see front-line caregivers and hospitals overwhelmed, as occurred in Italy. So if I err on the side of caution, that’s the biggest reason why.

    There are at least a few factors tugging me in the opposite direction—tugging hard, if I’m being honest. First, that same daughter won’t let me see my two grandkids—she’s afraid of catching the virus at work, bringing it home, and getting me or my wife sick when we visit…so we haven’t been with them in almost two months. That has me looking for reasons to side with “the crisis has passed” crowd. Second, as I run the occasional errand into Redding, I’m surrounded by people ignoring all of the recommendations for achieving a sort of prophylactic, ephemeral herd immunity. People aren’t wearing masks, maintaining distance, etc. Makes me think: I’m wearing a mask so that I don’t get these people sick on the off chance that I might be infected, and they won’t return the favor. F*** these clowns. Lastly: I miss tennis. I miss live music. I miss having a beer at the brewpub. I’m tired of this shit.

  4. Avatar Francesca Huntsman-Siemer says:

    Thank you Dr. Van Kirk. I think your comment about confirmation bias succinctly describes why we humans so quickly retreat to our corners on this and many other issues. The human mind is able to think and grasp logic, but our emotions are still swirling closer to our brain stem. (I might not remember my anatomy) and closer to our caveman/woman selves…… This is why we have education, science classes and history. To help us remember our past and see what the long stretch of culture/civilization and science have contributed to help keep us from reverting to our more primitive selves. I know there is more than this, but I don’t wish to write another thesis. Confirmation bias. Yep.

  5. R.V. Scheide R.V. Scheide says:

    Doc, I hear you. I’ve written five or six columns on the novel coronavirus so far, and most of them are really hard to write because it’s so hard to nail the facts down. I consume a tremendous amount of information online and force myself to read websites that challenge my biases. Dr. Daniel Erickson and Dr. Artin Massihi are the current darlings of the Corona Truth movement, they’ve got a political and an economic agenda, but their debunked study confirms the biases of the “It’s Just the flu bro” crowd, so they’re rolling it from Fox News to Breitbart.

  6. Avatar Patricia Bay says:

    Dr. Van Kirk wrote a thoughtful and poignant article. I also believe social media is rampant with confirmation bias. It is all confusing and exhausting.

  7. Avatar Bascomb Grecian says:

    What I do not like is the censorship of these two Doctor’s opinions. If you disagree, with their opinion fine. Shame on YouTube for attempting to pull their videos from the platform.

    Personally, I really enjoyed their views.

    If you realize this or not, this very article has a bias as well. I enjoyed reading it however.

    • Avatar Mark Stolzoff says:

      No one is entitled to a platform and YouTube is a private company that can do whatever they think is is best for their business. What you seem to want is State control of a private company. If you think youtube removing their videos is censorship you do not understand what the word means and you should look to that.

    • Avatar Mark Stolzoff says:

      “If you realize this or not, this very article has a bias as well. ”

      What bias ? Bias towards what? You keep using that word but I do not think it means what you think it means.

    • Avatar Miguel says:

      And your explanation for a public condemnation from his own medical specialty board? Dr. Van Kirk was if anything far to kind and forgiving.

  8. Avatar bruce vojtecky says:

    Here in Arizona the number of COVI cases is rising because of one simple fact, the number of testing sites are increasing. Any one feeling like there is a pause needs to actually look at what percentage of people have actually been tested.
    I may be in self isolation but my grandkids live with me so I see them everyday. Masks are worn everywhere and a lot of scams have ripped off people looking for masks. My wife made masks out of old T-shirts for everybody in the family. The Gkids do online schooling with their teachers and some other students are on there too.
    Governor Ducey is holding off on reopening the economy until May 15th. For some who want to defy his order he put it flatly, don’t risk your liquor license on two weeks. I do wish they would open the little neighbor hood parks so the kids could go somewhere, especially when the golf course across the street is open.
    President Trump will be here May 5th at Honeywell and I’m sure he will be touting Senator McSally.
    I would say I’m standing on a corner in Winslow shuffling chairs around but they are in the Navajo Nation which is under stay at home or risk arrest.

    • Adrienne Jacoby Adrienne Jacoby says:

      And is there a girl, my Lord in a pick up Ford
      Slowin’ down to take a look at you . . .
      Not sorry . . . couldn’t help it. Winslow, Arizona always brings those lyrics to mind..

  9. Avatar Ann Webber says:

    Dr Van Kirk certainly speaks directly to our tendency to confirmation bias, which is our comfort zone on most topics. Since this is completely new, sudden and overwhelming, we are tempted to lean towards the theory that we most would like to be true. I’m fortunate to be reclusive and comfortable with long periods of solitude, many are not. Thank you for the clarity on this topic.

    I would like to also thank Dr Van Kirk, who I saw once as a patient. You showed rare compassion and were so insightful to my emotional condition, especially as I was not an established patient. I’ve never experienced such a thoughtful, thorough approach from another physician.

  10. Avatar Chad Magnuson says:

    Silly me.
    I would think a confirmation bias is something medical professionals would have been taught in the early years of MED school to be aware of and to eliminate from their diagnosis and treatment.

    If medical professionals cannot apply this to their work ethics perhaps they are in the wrong business.
    DO NO HARM that medical professionals basic fundamental values are based on have certainly evolved to another level as displayed by these medical entrepreneurs in Fresno.

    • Steve Towers Steve Towers says:

      They’re from Bakersfield. I know at least one Fresno native who’d be offended.

      If you’ve been around the block a few times, you’ve encountered M.D.s who got into the field for the money, and secondarily because they’re God-complex power-trippers. Those two things explain about 85% of what you hear in that interview. The other 15% is pure ignorance.

  11. Avatar kirk harrison says:

    The difference between the bias in this opinion piece and in the article demonstrates why in fact the urgent care Dr’s press conference was so dismantled. They were passing off opinion as fact when the truth is that their data was problematic statistically. In fact, as Dr. Kirk said, it was hardly done at all and appeares solely to be a precursor to emphasize their other agenda. Statistical analysis and experimental design do not have opinions.

  12. Avatar Chris Solberg says:

    Let me shift gears for a moment…….Dr Fachi calls Remdesivir the gold standard and just today Gilead Sciences, Inc. gets emergency FDA authorization for Remdesivir to treat coronavirus as a stand alone treatment.

    I know its life saving properties are greatly increased when taken in concert with Zithromax Z-Pak for its anti-inflammatory properties.

    Which saved a friend of mine with a very serious case.

    Yet with all the great news about this drug their stock is dropping.


    • Avatar Miguel says:

      I would urge some caution in regard to glowing reviews of Remdesivir. While it is absolutely great news that something has actually been proven to show some promise .. that “promise” (while statistically significant) is for some rather modest improvements in outcome. Thus far at least.

      CNBC, Health & Science, Apr 29, 20 — Fauci said the median time of recovery for patients taking the drug was 11 days, compared with 15 days in the placebo group. — The results suggested a survival benefit, with a mortality rate of 8% for the group receiving remdesivir versus 11.6% for the placebo group, according to a statement from the National Institutes of Health released later Wednesday. —

      While this is certainly good news in every respect .. the results so far would indicate that it’s got some ways to go in order to be any kind of silver bullet against the disease.

  13. Avatar Dr Hyram Walker says:

    Confirmed accurate anecdotal evidence over time turns personal educated hypotheses or “confirmation bias” prophetically into tomorrow’s glorious cure.

    Im no Koochie Dr. but…

    Its called Science.

  14. Avatar Thomas Dolby says:

    I’ve drawn my conclusions and there is only one here Dr. Samuel Van Kirk

  15. Joanne Snyder Joanne Snyder says:

    Thank you for this great article Dr. Van Kirk. I saw the press conference with Dr. Erickson and Dr. Massihi, and I was relieved when I knew that they had been censored by the American College of Emergency Physicians. I’m preplexed about their motivation to share their ideas.
    W hy do we all feel like we are experts about things we know nothing about? Pandemics of the past including the Spanish (misnamed) flu and the Hong Kong flu have been studied for years. The fact that virus can jump host and become more dangerous has been studied for years. The reason you can go to an airport and walk into and use a bathroom without touching a door handle or faucet lever because of the solid research about the spread of germs and efforts to prevent the next pandemic. Thank you again.

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