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The devil you don’t know May 1, 2023

I remember growing up hearing the phrase, “The devil that you know is better than the devil that you don’t”. Or something like that. In other words, when we know who and what we are dealing with, when we have already been given some kind of secret knowledge about someone or something, we can more properly and more systematically handle the situation we are presented with. If I know a certain patient is scheduled to come in who I have pegged as problematic–let’s say someone with borderline personality disorder–I will prepare myself mentally and emotionally beforehand with a mindset that would likely facilitate a smooth discussion and hopefully proper resolution. 

I read medical and scientific literature, which I do often. I have become aware of certain sources that are not as scientifically rigorous as other sources.  When I read the news, some sources I have deemed to be more reliable than others. When I consider people to interact with, I consider my past experiences with them in order to formulate how much I trust them. The same goes for financial endeavors both in the personal and business spheres. I must admit that all of this requires some level of judgment on my part. Whether it is right or wrong, past experiences shape my future behavior and thinking patterns. This is true in not just me, but all of us. We all have an intrinsic desire to be safe–at least to some extent–in our surroundings. We don’t want to be fooled, or bamboozled. 

We love to be aware, to watch out for,  the devils that we do know. I don’t know anybody who rises from their bed in the morning and thinks to themselves, “How can I cheat someone out of their money today?” Or “Who’s reputation can I ruin today?” Or “How can I be a racist today?” Or “How can I be a bigot or a homophobe today?”  I know there are people out there who actually do think of these questions, but I would venture to guess they are rare. The devils of fraud, deceit, racism, and bigotry are pretty easy to spot. When we see obvious displays of these devils that we know, we tend to rally around in defense of the obvious victim and lash out at the obvious devil. 

We form social groups of like-minded people, and make it our business to educate others of these devils that are so easy to know. When these groups observe others who don’t quite see eye to eye with them on philosophy and practice of avoiding these obvious devils is when the devils that we don’t know start to creep in and take root in our psyche without even realizing it. 

I like to call the devils that we know the “knowns”. These are those obviously “flagrant fouls” we call in life based on our upbringing and personal value compass. These infractions are very obvious to us. Then there is a void called the “known unknowns”. These are things we think may be wrong, but we’re not quite sure about it. We didn’t grow up necessarily knowing they are bad, but we may feel a little uneasy about it. Then there are the “unknown unknowns”. This is positively the worst of the three, because it means we have no idea that what we are advocating for, may actually be extremely harmful in other ways that we never dreamed of. These are where delusions are formed. They can be scary. The fear of the “unknown unknowns” should drive any decent doctor, scientist, and epidemiologist to check and double check their work and the works of others to double down on eliminating bias. 

What is most shocking to me, as a regular medical clinical researcher (and filled with my own biases, of course), is the seeming breadth and depth of the “unknown unknowns” which fill the pages of peer-reviewed medical and science journals, national organizations,  scientific experts, medical boards, and fellow doctors, right now. 

For example, the American Medical Association, in their zeal to fight the devil we all know well–discrimination–for about 0.5% of the US population, unknowingly creates a situation that creates a devil that we don’t know–identity confusion–for the other 99.5% by advocating that they will “Advocate for the removal of sex as a legal designation on the public portion of the birth certificate.” In other words, they are creating an existential threat to the gender identity of 99.5% of the population to make way for the 0.5% who are intentionally gender confused. Why do they do this? Because their definition of discrimination includes any color, any gender, any competence, and anything else they deem discriminatory. 

I’m not here to pass judgment on the AMA, and I applaud them for their desire to rid the world of injustice, but I am curious–at what point do they stop? When do they acknowledge and understand the devil they don’t know? Although we don’t yet have data on the 99.5% who may develop gender dysphoria for no other reason than identity confusion, I would say that it will be very large. 

Gun rights advocates like the National Rifle Association support the freedom to carry guns and to protect ourselves from immediate harm by an intruder. In the NRA’s zeal to fight the devil we all know–coercion by the government–they don’t recognize the fact that the numbers of those acting in self-defense make up about 1% of all non-fatal gun incidents, while at the same time, guns are used in about 70% of all homicides nationwide. In addition to all this, on a state by state level, gun law stringency measures very significantly correlate with gun death numbers per capita. Meaning, the more stringent a state creates laws for gun control, the fewer gun deaths they have.  

Why does the NRA do this? Because their definition of freedom includes freedom to kill more often. Of course, they don’t want anyone to kill anyone else that is not warranted. But, in essence, that is what is happening. Like the AMA, I don’t want to judge the NRA. I applaud them for fighting for freedoms that make America a land of the free and home of the brave. However, is it worth the lives of the 70% of people murdered, to save the lives of the 1%? 

I could provide a litany of other examples to consider from both the political left and right sides. Just a few include: COVID vaccines for children, abortion rights, medical community standards of care, and smoking. All I am saying is that we all must, indeed–I must–look at everything. We must get out of our echo-chambers, even if we are called “experts”. We must stop taking sides on every issue. The polarization in politics has very quickly assimilated into the medical community. Now doctors, scientists, and institutions take sides to vilify the devil that they know so well. 

Can we not just take a moment to look at ourselves? If we don’t at least try to recognize the devil we don’t know, then inevitably, we become that devil known to someone else. This takes humility. This takes hard work, this takes knowing ourselves, knowing our weaknesses, acknowledging them, and working to correct them. We don’t have to be perfect. Nobody will be perfect. But we must start. Let’s start today.

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