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SI Digital Innovations in Learning is pleased to present
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The Jorge Lazarus Lecture Series on the origin and development of ideas in the clinical neurosciences. This course series consists of seven one-hour lectures with discussion
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The speaker will be Jorge Lazarev, Emeritus Professor of Neurosurgery, Department of Neurosurgery, Ronald Reagan, UCLA Medical Center, Los Angeles, California, USA Thank
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you.
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This is Dr. Lazarus introductory comments to his lecture series, and we quote, The most significant number of patients with diseases of the central nervous system live in low and middle income
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countries for no other reason than the majority of people are living in low and middle income countries.
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Let's start over.
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This is Dr. Lazarus' introductory comments to his lecture series, and we quote,
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The most significant number of patients with diseases of the central nervous system live in low and middle-income countries for no other reason than the majority of people are living in low and
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middle-income countries Nonetheless, neurosurgeons and neurologists from high-income countries offer most research papers on clinical neurosciences.
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This disparity is prejudicial to the neurosciences as a whole.
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We designed the course as an introduction to some of the tools that promote the genesis and development of research ideas
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This series of lectures are provided free to bring the advances in clinical and basic neuroscience to physicians and patients everywhere.
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One out of every five people in the world suffer from a neurologically related disease
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Lecture number four, induction, deduction, abduction, analysis of the ECIC bypass research project. Oh, yeah. Good evening, everyone. This is a fourth lecture of the neuroscience course
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presented by Dr. George Lazaref on the topic of origin and development of ideas in the neuroscience. We're honored to have you, Dr. Lazaref, and we can't wait to hear the ideas of today So, yeah,
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we can't wait to see the reading. Thank you. I will
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prepare now the sharing
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of the thing. You have had the PDF of this format. In the PDF, I did not put the right date. I used the other, but is the PDF is the
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August 4th And today, we'll go to this similar same way of - teaching through what I think you'll learn, which is by repeating and going back and going back and repeating the concepts, advancing
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one step on the two steps of the, of the path of the prior steps, you know, but for the next three lectures, we will go deep into the clinical, clinical significance of what we are learning
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so far or sharing so far Now, where are we so far after three past conferences that we have?
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The guiding principle, this is from the first conversation, the guiding principle of this presentation is the genesis of the idea, not how to continue the idea, how we come with the idea.
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What a research project, no? Ideas in narrow sciences don't come out of nothing.
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I came with the idea. So then from where the ideas come, and the ideas come only, only, only, only, only, from the observation of reality. This is a universal truth. The quotation you have on
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the left that says, Knowledge is a timefrom empirical familiarity is from that great physician and philosopher of the Muslim world, which is even Sena or Avi Sena, as we call it in the western side,
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no? Even Sena, who's teaching and philosophical approach to natural sciences, is present today, is constant today. As this is not this precise quotation, that's why the input is named. But
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that's that the synthesis I obtained from the Stanford Institute of Philosophy. And then also Kant on this side, he says the same thing as even Senor. And that those things were said many centuries
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ago or three centuries ago, doesn't change its validity. All our knowledge is attained through empirical familiarity with the object for which one creates universal concepts. You see one patient
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with fever and pneumonia, another patient of fever and pneumonia, for a patient with fever and pneumonia, you create a universal concept. I use fever and pneumonia. I should be using samples from
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neurosciences, but understanding that some of you may not go to the neurosciences, no? So
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when we face an object of knowledge, we start two mental processes.
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And the two mental processes that we discuss In the part we do in that term. Or we do the reduction. And there is a brain representation for each of one different areas of the brain are in induction
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when we see something that we recognize it. And the reduction when we decide to reason and process what we are seeing and learning. And induction is deliberation without attention. As you deal with
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the soccer, as you do when you look at an annual, for an annualism, say, Oh, aneurysm. Middle Serra, or either Cephalos, or Leoma, without thinking, just looking at the H-ray or seeing at a
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patient with a particular physical condition, you say, Oh, let me please you. It's a risk that is based on your experience, and of course, it's biased, right? If you see the H-ray of an
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individual who has an aneurysm, and also an aneurysm
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And at the same time, I said, Rosefalo, maybe if you are a vascular surgeon, you will see the aneurysm firstand the aneurysm first after. If you are
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an intensive care daughter, considered about preoccupied for the intercontinental pressure, you will see first the aneurysm first, and also has an aneurysm. And has fallacies semantic. One of the
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most common semantic fallacies is saying in every case. Really, in every case, always happens this. I mean, always happens this. Omission that you forget things, information, carcer, doesn't
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matter.
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And the direction is when you start thinking, it's certainly what are you looking at and how can you understand better what is happening. And the two tools are modus ponens and modus tolerance,
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which we will review again today with you. clinical example. And it's robust. If you do it well, there's no holes in there. It's a boom. It's a perfect
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situation. So there you have all the samples. And those things happen to cardiologists when they look at the electrocarogram. I don't know what the electrocarogram shows And looks to neurologists
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or neurosurgeons who see the mediatic pupil of this child. Pathologists identify the leukemia. Doctors from South America identify the sign of Romania, which is common for Jaga's disease. And Dr.
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Haus already knows, the first thing he knows what the angioshows, which I will not tell because I don't know. I'm not that sure. He's an aneurysm there. Some were there, there is an aneurysm.
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But Dr. Haus can tell me, three minutes about this aneurysm, I can. I can talk three minutes about the sign of Romania or about soccer. And it's the same thing everywhere, in everything. The
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president of the country, the head of the intensive care unit, everybody because we as human have the cerebral representation for doing the dachshon or doing the dachshon. So the dachshon and the
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dachshon helps you to become a great clinician, a great surgeon, a great
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engineer, teacher, coach of a soccer team or a tennis coach or president of the country, or ruler of the country.
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That's the dachshon and in dachshon, how you use them, how you know the perils, that makes you who you are and who you will be but
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the purpose of this set of conversations that the purpose of having you late on a Friday evening in. But that, another areas where you are, is to help you build a career as a clinical researchers,
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specifically in the neuroscience. So, but to be a researcher, you need one step forward. And that step forward is only abduction It's not a step forward invented by Lassarif tonight, that, oh,
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I have to give a lecture to the, or a conversation to these people from Iraq. What, what I tell them? No, no, no, it's abduction is in the book. There is no way, and I will show you how today,
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proof one time and another time, no? So, abduction in the philosophical literature, it's a form of explanatory reason It's plain with reasoning. That is a bad change. And that change tells you
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this is soccer. The bad change gives you a saying, yes, because there are 11 players. But tell me, explain me this game that you are looking at. And
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that is the process of forming explanatory hypotheses. Is the only logical operation which introduces a new idea. There is no other and ideas come through a logical explanation of something that you
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see.
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And that is the origin of the falsibility, origin of all the other situations. It's a explanatory hypothesis through abduction. So in every case, we have a patient, in every case medicine. A
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rule and a result, right? In the dachshund, we say, in the rule, in patient with a sapara and haemorrhage, and bradicadia, considered elevated into cana-pritish. Yeah, the patient had a
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broken aneurysm, right? But there's no, there is blood on the, on the system. Well, maybe he has into cana-pritish. And
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patient sapara and haemorrhage, as bradicadia, result, we started treatment with many toilets, another ventricular, the brain, and in this manner, the daughter, the intensive care, the
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uni-daughter, save the life of the patient. Because, you know, the rule, the rule that you learn, the induction patient
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sapara and haemorrhage, haemorrhage, haemorrhage, haemorrhage, haemorrhage, haemorrhage. You are already an experienced, uh, intensive care, uni-daughter, it's billions neurosurgeon, it's
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billions urology, and say, No, this, this, this patient has its their, their has. into kind of pressure, needs an extenobentricular drain, needs many toll, needs follow a
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MRI, tata, tata, without any at the conversation. And you also save the life of the patient. So those two things, as I said before, helps you become fantastic clinicians or surgeon, great
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doctors, the doctor and the doctor. You have anything more. But the doctor is the one that will leave you that will tell you to the next step, as expressed before, in the same scenario,
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abduction, the rule. We start with a rule in blue, like the abduction. In patients with upper enemos, somebody carry a concider elevated in caribbean.
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Result, we start the treatment, start with money, toll, and a son
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of ventricular dry, and the hard-right decrease, and you save the patient's life.
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If you want to start a new research career with this patient, then ponder. The patient with saperanine hemorrhage, with saperanine hemorrhage is the
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asbradicaria. But why this patient with this ventricular size? I know the other patient I saw last week who had same ventricular size, same age, same size of the ventricles, but this one was
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collapsing with bradicaria We really needed to rush him up. And the other one, it was fine. We just could wait for this ventricular drain that the nurses couldn't find. But they did fine at the
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end. What's the difference? What difference? So, and I am inventing, you know? So you see, well, maybe this patient, the one who had such a, this patient, the one who didn't have a
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tolerance for ventricular pressure, You see on the CT scan, there is blood in the ambient system. Or you see in the CT scan, there is blood in the purple time system. And the other one didn't
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have. Is this a photo? Or is it not a photo? So, the patient is fine. The patient, whatever, with blood in here or blood in there, doesn't matter. It's fine. You save the patient's life.
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You save the patient's life And the patient is grateful. And then they would click the aneurysm or they would symbolize. I don't know, whatever treatment, right? But the experience of the
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research
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has been sort of lost or wasted. Not that you have to be chasing every case to see what happens. But if you have curiosity, if you say Mr So and so, at that rapid. deterioration. I said, Gee,
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I remember Nissi's so-and-so last week. She was doing fine. She tolerated the fine. Then you go, then you pull out the CAT scans, or memorize, or whatever studies, and start looking. What's
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the difference? Why this patient had this? That is the issue of the research. Then, when Samuel Vays remember, he was talking about the women in the world, one or two, the women as a general.
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But then, one particular person, his friend, college kahad, and he said, Why college kahad this? The case of AIDS, that I spoke about last week, I think, and two weeks ago, also. Those five
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patients, why this patient has? No, this This is a cup of sicercoma, a blemocysticarene, there is something I have to do for that.
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and the outcome could be good and bad, goodbye. But those guys say,
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what's happening? Why this guy and the other guy and the other individual had this? This is what we call abduction. So this motivational talk is very nice, Professor Lassarif, but we are young
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physicians who are about to become physicians in a year or two, an aesthetic scope, and the internet are our only tools, and more importantly, there is no mention in the textbooks about the
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relation between the blood in the ambient systems and bradicardia. Well, that's the beautiful thing.
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Maybe it's another relation, ambient systems and the bradicardia. Maybe I just made it up. Maybe the ambience is, you know, sometimes the separation hemorrhage goes into the blood, goes in the
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ambience, and sometimes it doesn't. Does it make a difference in the process of vasoconstriction and the clinical outcome? I don't know. But maybe we'll have the, and I don't want to personalize,
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we have the rule that has your name, and that's it. So philosophers who thought about the problem of knowledge and whose words are relevant to medicine, I mentioned four, remember, I will discuss
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one, we will review that one,
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following the thought of abduction, and following the thought of abduction, we also will discuss the second one. Why? So, it's not professor Lazarus, but the infinitely more important and
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relevant professor Popper, nobody knows about me, it said you, how many are we that know about me? I don't know, 30 something, how many we are now, 40. But Popper, come on, his Popper is
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well known, right? And who is telling you, All of you watching this lecture, he popped, but he's dead. But through his writing, he's dead. telling you that all true scientific theory accepts
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falsification. The demonstration that is true until and when someone provides it false. That's the case with AIDS, say for example. First, it's only a message. Only hate him. Only I'm a feeling.
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And then now we understand. Only those who are infected by the virus. That gives a better understanding. And the same advice and I don't want to go back to that. So every theory, every true
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scientific theory accepts falsification. And that is true for the every important neurosurgeon in the country or every professor of neurosurgery or neurology or clinical neurosciences to whom you
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will send your application for the training If he or she is true.
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personal worth, he has to be ready that your brain minds, brain minds will be maybe falsifying some of the concepts that are the structure in there.
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When I finished my training in neurosurgery, humans were three volumes this size. Now it's five volumes this size And this is not knowledge through electron microscopy. This is knowledge through
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clinical observation, through sending to find it. Anyway, so that's what Popper says. And then abduction is the process of forming and explanatory hypothesis is the only logical operation which
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introduces any new idea. Which are those logical tools requiring for introducing new ideas, modus ponens and modus tolerance.
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those are the two tools to where you introduce no ideas. And more responses are feminine. If A, then D happens A, therefore B. The silly example in the logical textbooks is I don't know, if it
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rains, would you say the department will be wet, the department, it rain, thus the department will be wet Of course, A is often the body of knowledge of a thing. If you say A, if you have
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saperine and hemorrhage, then you will have, most likely, either Ocefalus, because of the abstraction of the saperine space by
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the blood products, you have saperine and hemorrhage. Therefore, you need to be ready to see Irocefalus.
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You, you would, I can see when I'm talking about a is not just a and one sentence is the whole body of knowledge, implying again, another thing, the whole body of knowledge. The problem I see
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with logic is that all the samples in the, in the textbooks are silly. If the door is barking, then there are intruders I mean, who cares, the dog is barking and intruders. A is the body of
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knowledge about a subject, you know. So, and the.
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So those those a and b are premises. They are linked through connected phrases, therefore, in consequence, if, if we have a supper and an hemorrhage Therefore, we need to think about the
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possibility of the patient having an address for us. And the connection has to be adequate and relevant. I receive for us. Why are you. Well, why? Because the blood products in the soprano space
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may create adhesion similarly to meningitis. And that will delay the flow of cerebrospina fluid from the
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choroplexus to the granulations in the top of the skull. The
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premises don't need to be one short phrase. They can have many paragraphs. They can have a book coming from a premise A, the antecedent, B, is the consequence. Linking together will reach a
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conclusion.
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Since it sounds very extremely simple, like what this is similar to when the teachers taught us how to read and write, you see how simple. Yeah, but without knowing how to read and write, you
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don't go anywhere. Well, that teacher in first grade is the one who built you now And this is the system.
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that allows you to go forward as a research. I will show you now. So the famous thing, if I see over and over this, I can formulate that all swans are white, right? So we went to that.
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So you create a body of knowledge and you create a scientific theory that all swans are white because after seeing the body of experience, according to Kant, according to even Sena, all knowledge
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comes from experience. We see all swans white, we see all swans white. So then we go next time to a lagoon or to the zoo, what we expect is to see white swans. But one day we go to the lagoon and
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we see a black swan.
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So that theory that says the genetically confirmation of swans in the planet Earth are that all are white, well, no, it's not true, it's not necessarily true. And how it was proved, it was
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proved through observation and through observation only. So you create a new knowledge according to Avicena and Kant and everybody else, you have created a new knowledge. All the theory of the
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swans being white has been challenged by the presence of one blood swan.
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We told you last Friday, the idea was that AIDS was fatal. The
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experience in every hospital in New York, in San Francisco, anywhere in the world, in Europe, was that you have AIDS, you die because of the capacity and the immune and all those things And then
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one day.
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the black swan appeared. I told you this famous actor, PMG, who was walking in there in the corridors of UCLA every three months, bringing that the check of the donation because his wife and son
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died of AIDS. Therefore, he was overly exposed to AIDS, right? He had an unprotected sexual relation with a woman in such a form that he produced a son, the mother and the son died. And he was
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walking every three months through the corridors of UCLA because that was in the late 80s. You needed to bring the check, the actual check that the money he collected through donations. Thousands
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of times, doctors, maybe hundreds of workers saw him until only one stop and he says, You are the Black Swan. You are not dead. And then they started looking and they found that, yes, there is
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a population of people that they are not dead. remind me for the end if we have time or the next, how they confirm that there are many other people. That's an interesting story, but I don't want
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to go through the side. So what we have is a model stonens. We deny the consequence. So you say if all these ones are white, then every time I see a swan, I will see a white swan. And then one
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say, no, I see a black swan. Therefore, all these ones are not white.
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And now I know that I'm abusing of your of your patients. And I hope no, that you are saying what this has to do with the research. What we will do with the research is this precisely that if you
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of what you are when you do research, you are looking for that that thing. that escapes the norm, right? All patients with a rusepharosa's bradycardia, yeah. But why this patient has more
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bradycardia than these other and why this one doesn't have bradycardia, it's part of a huge volume of
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it. So a failure in the antecedent is the logical structure of a scientific theory. If A, after seeing hundreds of wise ones in life or in pitch alive is a conclusion that all swans are white.
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Therefore, in consequence B, next time I see a swan, it will be a wise one. I saw a blood swan, not a wise one. Therefore, my theory is not correct.
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important to keep in mind is to propose a new idea is to add another layer of knowledge to previous ideas.
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We tend to be in medicine particular confrontation Oh, Dr. Hoss doesn't know anything. I know everything. Oh, Dr. Hoss says, Oh, Professor Lazarus doesn't know anything. I know everything
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because I saw one patient that doesn't agree with what I said. No, no, that's
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a confrontation. Popper uses falsification and it sounds very aggressive Nonetheless, when he proposes the explanation of the dilemma of the color of the swans, that the color of the swans is a
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dilemma of Popper. He's in his major book. And the color, his language is more nuanced. He's kinder. He's nice. He says, not all swans are white
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The Witch. when you see something different in your war rounds or in your practice as researchers, you say to your professor, not all either of the safest patients with a parietal hemorrhage need
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immediate thing.
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And not all patients with this particular disease have that outcome.
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And this is what creates, stimulates your curious mind. This is the idea of the origin, the origin of the idea. So you are possible to actually think that there is many people who thought about
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the problem of knowledge agree that yes, not all the answers are now even in 2023 in the textbooks Furthermore, I believe 10 years ago. they found pink swans.
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And that is interesting, you see, pink swans. So if somebody would have said the swans that either black or white would have been wrong too, not all swans are white.
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And the tone of the argument is said is very important, not just because it's the right approach, because it's not logically, it's not correct It is incorrect to say you are wrong. The correct
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manner to present your argument is in such fashion that builds new knowledge standing on previous knowledge. Examples come in, don't worry. I know it's boring this time, all the theory, yes, yes.
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How many times are you going to tell that? Well, one or two more times and then we go to the example. So, very nice, but what this has to be done, do with clinical neurosciences or even medicine
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or anything but swans. An analogy, and I believe this is the Arabic expression of analogy. I checked that with Professor Hoss a week ago, is a powerful tool for reason. It's a powerful tool for
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reason. You do analogies. If you remember the two swans, then you replace the swans with either safe alloys or bridges or anything that your profession interested you. The example. Yes, I am
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okay on time because those are stories. The famous
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ECIC bypass in
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1967. So 52 years ago. And I can see that aroused the interest of the professor's hospital because he light up his image now. I mean he heard ECIC
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by Whoa, whoa, whoa, what is going to tell about that? I know about that. And he's a duvascular surgeon, so he knows about this issue. But in 1967, the first superficial temporal artery to
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medial cerebral artery bypass procedure was performed on people. The theoretical basis, the A, was that the operation was to provide extra blood flow to the brain in those patients who were
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suffering from symptoms related to decreased blood flow It's the same principle of the farmers. This part of the land is dry. I want to have a good crop. I try to divert blood, I mean, water from
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the river and make a stream that irrigates that area or I bring sprinkles or I don't know what. That is the principle of ECIC bypass. And as you can see, what I'm using now is an analogy. I use
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the analogy with the farmers and the water and the land. It's the same analogy people use for the brain.
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And that was the famous operation that was done innumerable times. And until sometime in the '80s, the
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scientific community decided to see whether it was right or wrong. So they did a loan study, a prolonged study, on to see whether
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ECICF's intra-cranial bypass was useful.
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And
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our research that I didn't take anyway, I don't remember. So the results of the ECIC bypass study were presented at the International Policy in 1985. I already was doing a fellowship in that time
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and were published in the New England.
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And the following conclusions have been drawn by the trial of investigating. BIPAS surgery is no more effective than the best medical care in reducing stroke or stroke related death.
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Goodbye. That shot completely, the training, the thinking or the thing, ECIC BIPAS,
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didn't help. If you had a
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carotid artery that was narrow or a middle cerebral artery in our row or a slightly rotted vessels in the brain and you were in danger of having stroke doing a bypass from the superficial temporal
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artery. Usually to the middle cerebral artery, did not help.
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Well, so we have the induction, we've got through the deduction, some of the modus tolerance, modus ponens, they said, if A, then B, A, therefore B.
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reached a conclusion that yes, indeed, bypass was not important,
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but some clinical neuroscientists
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had patients that benefited from the ECIC bypass.
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There were surgeons that they say, but how come? I mean, I did one last week
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and the patient did well
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So the abduction they use without knowing, but they use it, the abduction rule, which the abduction rule EC bypass doesn't work, result, I did, and I see bypass and well, supposedly shouldn't
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work, but it's working.
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So they use the model's tolerance in the sense, denying the
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consequence. And they did that, and it's not the time making it up That is what actually. happened and professor was not. So in deduction that was useful at research, based on the cooperative
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study, patient with even a high risk of his family's analysis should not receive ECIC. The patient, this patient has his chemical analysis. The result, this patient will not have ECIC bypass to
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agree with the rule determined by the cooperative study. No, but when you remember, induction is patient
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rule. I mean, patient result rule, the reduction is rule, patient result, abduction is rule, result patient. A rule patient with his chemical analysis should not receive ECIC bypass. The
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result, this patient will not have an ECIC bypass to agree with the rule. But this patient, but the doctor says, Yeah, but this patient has a unique demographic as a unique engine. I'm talking
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about Angie in that time, 1980, and you need CT Angie.
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This clinical system, he has in risk of a posterior circulation. Stroke. Stroke is not, is danger of stroking or
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not as anterior, more anterior, more posterior. And you decide whether this patient, you decide, you, the 40 or something of you are there. This I, whether this patient is the general rule of
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if her case is a unique case or he's appropriated. And if so, why? And that resulted on a very important paper, fundamental paper by our own Dr. Osmond. When he was the Dr. Osmond, he's the
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editor of surgical neurology international and in surgical neurology digital, these videos will be uploaded once I made some, some some of the corrections.
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He wrote and this time,
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he says he had a big experience and then he says at this time there has not been sufficient discussion of this report and the questions raised in it have not been appropriately answered to satisfy the
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physician skilled in the use So you see he says, he's living an explanation what happens, they put together surgeons who did hundreds of bypass with surgeons who did just two or three bypass a year,
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20 bypass a year or three bypass a year It's a different skill, different understanding different person, they all they work together.
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And also because this trial only involved patients with ischemia to the anterior circulation, non conclusion can be the wrong regarding bypass surgery. to the vertical by basilar circulation.
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Many of you were not born. None of you were not born, except Dr. Oz and I. And
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they in 1987 when this happened was a big thing.
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In a big thing in the neurosurgical community was shaking to its foundation by the finding that this fantastic analogy that if you bring water before the drop, you will prevent the drop and the crop
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will be better,
40:29
was not true. But then that was in the action, that was the action, but then through abduction, not necessarily that they thought like that. I'm sure Osmond, and I think it's one of the
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brightest men in that I know, Dr. Osmond, Professor Osmond is not very familiar with the principle of abduction, Bob
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is again, that the proof that when you think of the patient, when you think of your own outcome and not overwhelmed by the rule, you start a thinking process, not all the time you will be right.
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Maybe you will find a thinking process that, yeah, complies the general rule. But you are opening roads that give you ideas of how to continue your research. This presentation is about the
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developing of the ideas. Philosophers who thought about the problem of knowledge, we talk about popper. Let's talk about this American guy, Willard van Orman-Kwein. As you can see, all, let's
41:40
say, fleck were born in the past century. So almost our contemporaries. And Kwein, what Kwein
41:51
said, He said something that Osman proved. without knowing. Under a termination is a thesis that for any scientifically based theory, they always will be at least one rival theory that is also
42:04
supported by the given evidence and that theory can also logically hold up in the face of new evidence. This is the powerful thing. And this again was not said by some
42:18
unknown guide. This was said by one of the preeminent philosophers of science, professor of Harvard and Mary, to Wilma Arthur, so many who quite was saying for every theory or for every scientific,
42:31
there are two explanations with the same data. I am making it up, no. He says here, Ausman confirms crime. Because he says, One, the skill of the surgeon, and two, the location of the
42:51
potential stroke So using the. and which we have, so when he's making an argument against the ECIC bypass, he's using two different, completely not related
43:08
explanations for the failure of what he considers that the failure or the imperfection of the study. I believe that you're following me, no? So coin is absolutely right, and what I'm going, coin
43:24
is due. Under the termination, it's a thesis that for any centrifugal base theory, the centrifugal base theory of house monies, the EC bypass study is imperfect.
43:37
I'll be at least one rival theory that is also supported by the giving. He says, is imperfect because of the skill of the surgeon? Yeah, but it's also imperfect because it's on, they focus on the
43:50
posterior circulation. With this, I want to actually tell you,
43:55
And I will show you two or three more examples, that the field is open for you, for you, for you, for you, I don't have all your names in front of me and I don't want to personalize. The field
44:09
is open. The field of innovation of coming with innovative ideas in clinical neurosciences is open And I'm not saying that trying to be nice because it's nice in bad that and you're making the effort
44:28
and how nice professor lesser know I just showing you that people much more important, more relevant than I said that. And there are hundreds of proofs like that I choose those two so I don't worry
44:42
you like that no
44:44
So, what coin says and what is the, what is the think of And that is the explanation. how you explain something.
44:59
When Osmond and many of the neurosurgeon says, oh, this study is absolutely stupid. I'm
45:07
fine. Hundreds of voices said this study is wrong. But only Osmond and Dias said explanation. I think it's wrong because they don't look at the
45:17
skill of the surgeon and they just focus on anterior circulation Okay, that's an explanation. Does the paper is published? Does the paper has been quoted? Does the paper has been discussed? And
45:33
the ECIC on study next
45:35
bypass will include the two objections by Osmond and
45:42
Dias. An idea has been forward. The idea that you forward is the explanation One fascinating scene in
45:53
the story of the medicine.
45:57
gastric ulcer.
45:59
Gastric ulcer has preoccupied for centuries, everybody.
46:07
And
46:09
in the 19th century, in the 20th century, I'm sorry, around 1970 or something. And people start paying more attention to gastric ulcer.
46:21
And then you have these individuals on the right, steer and Colin Jones, who look at the gastric ulcer, and based on other papers in the past, they noticed the presence of a bacteria
46:37
and the gastric ulcer. They thought that the bacteria was civil morna, it wasn't civil morna, we will see that later. But they found the bacteria and they found the gastric ulcer.
46:53
How did they explain the And I'm simply fine, but how did they explain? And I can send that paper to you. Anybody who wants to read it is wonderful. It's a wonderful piece of history. How did
47:06
they explain what we were looking at? They say, Aye, there is a lymphocyte infinidrakearound
47:13
the gastric acid, which is caused by the bacteria. Which is true, there is
47:18
a lymphocyte infinidrake, but it's caused by the bacteria, right? You have a bacteria, you have a lymphocyte infinidrake, but that's what you have They are interesting. And then they say,
47:31
Chiodomonia ariginosa was found in many specimens, and evidence is presented, that this was not a contaminant. An interesting point, remember that we learned, and at least I learned in a medical
47:43
school that no bacteria grew in the stomach because of the acidity, or the gastric juice. Now, you, junior students, don't believe that because of that, but I.
47:57
I would have been
48:00
dismissed from class if I ever say that there was a bacteria in the gas, in the, in the gas to the mucosa, but these guys found, these guys founded it and, and they say it was fine. Many
48:15
specimens, carbon alert, Sony appear to increase the amount of mucus. It was a drug they were trying, but that little effect, the possible contribution of celluloma and aeruginosa to gas
48:27
reconciliation is discussed, but we didn't pay attention. We focus on the lymphocytes and the caroloxone.
48:37
A few years after, seven or seven years after, two guys in Australia, in Perth. Perth is a city, is a third of four cities in Australia It's smaller than, but that, and many cities, smaller
48:55
than. most smaller than the bill. And he's on the western side. All the big thing of Australia is on the eastern side, no seed name Melbourne, Canberra, and Perth is on the other side of the
49:08
country. Pathologist, Robin Warren then, was looking, and he was seeing the bacteria and the thing, the bacteria. And he came with explanation. He says no, and he mentions Colin Jones Colin
49:23
Jones observed ground negative in 90. You see, he mentioned he builds on the
49:31
antecedent. He doesn't say the idiot of Colin Jones. No, I say no, professor Colin Jones, respected. He found that, so he sees that. And then he says, but wait a second. Maybe the bacteria
49:49
causes the ulcer Maybe gastric ulcer is a. caused by the bacteria.
49:58
So they actually he gathered the interest of a resident of gastrointestinal neurology, internal medicine then, by remulsion. And they say, just look at all the specimens we have.
50:15
They look at the specimens, and they found, yeah, that
50:20
50 or 60 of the specimens, there was a bacteria, and there was the gastric cancer.
50:26
Good, not in 100. And they published this, and they did it at the study. I will tell that the study, but the present study, was designated to confirm the association between gastritis and the
50:40
bacteria, gastritis which leads to gastric cancer. And then, although cause and effect cannot be proved in a study of this kind, we believe We believe. that pillory campilobater is atulogically
50:58
related to corona probably to pettid ulceration also. This paper gave those two guys the Nobel Prize of Medicine,
51:09
five or six years after.
51:12
We believe, I don't know, then my explanation is that, you know, this bacteria causes the ulcer
51:23
But, listen, Colin Jones and Steel Steer and Colin Jones, they were looking at the same thing, but they explain it differently.
51:34
You are looking at one problem is the value of your explanation. And the value of your explanation doesn't have to come from Washington, DC, or from Los Angeles, or from New York. The value of
51:49
your explanation can come from Perth, Australia. Yeah, they. have better right English ability than we have that doesn't matter that the paper is written in present tense, you know. We believe
52:05
that this is that, and this was published in the Lancet and the other one in an important journal, and you see two different same observations, two different themes. One interesting term, and
52:20
also if you read that paper you will see that not everybody, not every one of the patients. I mean, 60 of the patients are that. But they forward the hypothesis, when you do the supposed study on
52:35
bradicardia and blood in the cisterna ambience, which are invented now, you don't have to see every patient in the scene, but you have to have an explanation, maybe the vasoconstriction at
52:50
the level of the cisternabians or the anterior portion of the medallal or the brainstem or the middle brain, promotes this interruption of the flow of the schema of this track. That's it, it's an
53:03
explanation. The interesting story, of course, what led the thing, Marsha and Warren came with this thing, and they send the abstract to the Australian Society of Gastroenterology. And they
53:21
absolutely rejected.
53:24
In that year, three papers were rejected, all the other papers, so they are accepted everywhere. That was rejected. So what they did, Barry Marshaan was the younger. Ah, the identification of
53:49
the, the identification of the bacteria had an interesting story.
53:56
they send the bacteria to the laboratory of microbiology.
54:03
The microbiologist led the samples last two days and after two days they discovered, if the sample was negative after two days they discovered it. But
54:17
then
54:19
comes the long vacation of the in the Christian Easter Easter vacation from Thursday to Monday, Thursday, Friday, Saturday and Sunday, nobody works.
54:33
They sent the samples on Wednesday, nobody on Thursday to throw it out, nobody on Friday, nobody on Saturday, nobody on Sunday, when they come back on Monday they find the bacteria grew because
54:45
the elico barter pillory
54:48
grows after three or four days. Okay, they found his elico barter pillory. So they said that the abstract to the Congress and the Congress did not accept it.
55:03
But they still were convinced. This is the study where they just look at the thing. So what Barry Marshall did? He got a vial of alicaba. He had an endoscopic assessment of his stomach. It was
55:20
clean, normal Young man, 30 or something. Took a vial of alicobacter pylori. A few days after, he was nauseated. He had bad breath. His wife asked him to go to another room. Really, he's not
55:40
waking up. And
55:44
another endoscopy, a field of ulcers, antibiotic treatment,
55:52
another endoscopy. any govert the pillory kill, the ulcers will heal.
55:59
And that's it.
56:02
Without going, I don't want you to do angio, cerebral angio on yourselves. It's not
56:07
the intention of this, of that. But actually to go back to this, and this was published on the Lancet, when it says the cause and effect cannot be proved. I'm seeing these samples here. I'm
56:22
seeing these samples there And I imagine if A, then B, A, therefore B. They did them at the model's telling, model's points. A, then B, A, therefore B. But I cannot prove, but I believe.
56:39
So that was the power of the explanation. And I go back to the slide number three or four of this presentation, and that was presented also last week,
56:53
Abduction is used to refer to some form of explanatory reason.
56:59
It's called inference to the basic explanation. Abduction is a process of forming an explanatory hypothesis. It's the only operation which introduces any new idea. Now, to form an explanatory
57:15
hypothesis of something that you see, you need to have two things Knowledge on the subject, having read and know about soprano hemorrhage and the ambient system and the relation of the ambient
57:27
system. And you need to be courageous.
57:32
You don't have to have complex. Oh, I am a medical student from Iraq. Hold on, I don't know. If you see that, and your explanation is reasonable, is based on something, then tell it.
57:45
And if they tell you that you are crazy, that you ran, that you're absolutely doesn't deserve it, well, too bad, I will continue.
58:03
It is exactly what Marsall and Robin did. Marsall and Robin didn't have any electron microscopy, any money, and they had ideas and they had courage. And before that, they were completely unknown.
58:09
Not having you, yeah, people in the hospital knew they were, but not in the community, right? When you forward, you observe something that is interesting that attracts your interest, and you
58:24
come with a reasonable explanation using modus ponens, modus tolling. If you remember that, or not all swans are white, if you remember there is a possibility of flexibility, if you remember that
58:40
there are at least two explanations with the same evidence. In the past example, steer and jones, calling Johnson Steer, they explained what was seen.
58:57
that there is an increase of lymphocytes, as Quine says, there always are two explanations, the same body of evidence.
59:02
And that increase of the lymphocyte was published and went to the medical textbook and even was part of the knowledge because Marshall and Robin here preferred to it. In 1975, Stephen Conelland also
59:18
was part of the thing. So, but that explanation as Quine says, there are always at least two explanations with the same evidence. One decided to explain the lymphocyte and the caromaxobrine,
59:35
whatever, and the other there's another explanation. No, no, this is the ulcer. This is the cause of the ulcer. So, the difference is in the explanation. Both statements can be correct.
59:51
Both statements about the ECIC bypass can be correct. Yes, doesn't work, doesn't work for anterior circulation. Doesn't work if the surgeon is somebody who does only five cases a year, which is
1:00:05
to say that both infinites are correct. But one of the
1:00:09
infinites is the best explanation. The best explanation for the presence of ulcer and dastardis, the bacteria and an ulcer
1:00:20
or dastardis, is that the bacteria goes into dastardis. That's the best explanation. The best explanation to see why some of your patients do well in spite of the ICIC bypass that everybody says
1:00:34
doesn't, what is it because you are a good surgeon?
1:00:38
You are skillful, you have done 50 of those, a year or something in your life, I don't know. And because you are dealing with a posterior circulation So the difference is the explanation and the
1:00:50
explanation of what? explanation of something that attracts your interest because you see it and you see it where you see there tomorrow or Monday or Tuesday when you go to the clinic.
1:01:05
But that what you see has to really catch your attention, has to be somebody whom you have compassion for or is your friend or I don't know, many anything. So this was, as I promised, was the
1:01:18
last
1:01:20
next week we will talk in specifically to Kiri Wan, specifically to one case of Leoma and the other week we may talk about specifically about ethical things and I promise I will not mention abduction,
1:01:35
maybe one slice, say, remember abduction, you know, remember explanation, abduction is explanation. So you generate the ideas by looking, doesn't say or philosophy, The most important.
1:01:49
natural philosopher of the Muslim word said that. And the most important philosopher of the Western civilization said that. It's not that he's there through experience. And experience is what you
1:02:04
get when you go to the world, pay attention to the
1:02:09
phrase and say, yeah, this is the anyways, yeah, okay, this yeah, but what is the blood? What's the blood when? Why in some patients, the same bleeding, the blood goes this way and then it
1:02:20
matches and then they go that way, another one goes down to the fourth ventricle.
1:02:25
If I look at an H-ray of a Saperate on hemorrhage, can I predict the outcome based on what I see? For that, of course, you have to have curiosity and knowledge. And then to show the people, you
1:02:38
have to be courageous, which you are. Thank you, we finish mostly on time. Thank you, thank you. If there are any questions, please.
1:02:49
or
1:02:51
while you're thinking, I'm not forgetting that I promised that the videos, the videos will be there, but as I'm reviewing, I'm seeing that sometimes I don't make clear some concepts which was I'm
1:03:04
talking free and some videos I may be record some portions again. So I'm trying to give you the best possible experience with this thing
1:03:20
And I may say thank you anyway, thank you guys. Thank you, thank you, yes, Mohammed. I say, no, Rania, I thought the question, yeah. I mean, you run that, yeah, go ahead. Well, there
1:03:35
are professor, can you hear my voice? Yes.
1:03:39
Thank you for your presentation. Your efforts are highly appreciated. My name is Rania Hussain and I'm sixth grade medical student I hope you remember me. from the last lecture that you offered. I
1:03:51
asked the question and your answer was very clear and I highly appreciated. I'm happy that I'm becoming more familiar with the concept of deduction, deduction, and abduction week after week.
1:04:08
However, I have one question if I may. Please, and then Mustafa after. Yes, yes, go ahead Okay, are there any limitation or challenges associated with each type of reasoning, like an deduction,
1:04:23
deduction, and abduction, in terms of drawing an accurate conclusion, or there is a general limitation for the whole concept. Yeah, the main limitation to induction is the once four or five
1:04:41
listed over there, is that we tell to be heuristic and bias. If we, or as we say, if your only tool is a hammer, every problem has the shape of an ale. So if you are a neurosurgeon or a
1:05:01
neurologist, or if you saw all those patients in the clinic or neuro clean it, you forget that there are other etiologists, other explanations for that. The other thing is that when they, for
1:05:17
example, the ECIC bypass came, it was run by prestigious vascular surgeon, Dr. Pierce, who was an assistant of Dr. Drake, he would run the study. So you have this adominem thing, you say,
1:05:31
how come I, or me, not me, I mean, imagine a dialogue from this humble portion of the world to an object, somebody in the power will set, and the study was subjected by somebody equally powerful
1:05:48
to those guys, by Jim Hausmann. I'm sure there were many other neurosurgeons in the world who may have had some thoughts. So that bias, he resisted bias. And I wouldn't say, I mean, authority
1:05:58
has to be respected. This is, of course, because recently and otherwise, what we'll be fighting all the time with each other with our ideas But then the direction, the direction usually, the
1:06:01
relative method well done doesn't have any fallacies. And abduction is part of your curiosity. But of the
1:06:25
three fallacies or the three problems, abduction is based a lot on the direction. It starts with a rule. Only ends in the patients, starts with a rule. And that, for that reason, the direction,
1:06:39
um, that's an abet that, in that has many holes as far as it's, you know,
1:06:47
Yeah, but very clear. Thank you, Professor, for your answer. Thank you. Mustafa, you are raising this. Yeah, thank you, Professor Lazar, for this
1:06:58
collaborative talk. Actually, this is very interesting for me. Just a follow-up question about Rania question. As do you find quantum mechanics like in physics some has sometimes limitation with
1:07:16
these like Aristotelian logic like A and B. Then, for example, C, and quantum mechanics, there was problem, for example, of superposition, like maybe A is also B at the same time. This can
1:07:20
occur in the real world So, this time maybe
1:07:43
of operational logics may not work projects may not work. like, do you find this an example here in quantum mechanics as a limitation? No, I find, I mean, I don't know that much, but I
1:07:55
understand I'm unfamiliar with showing your cut. I don't know if it's related to quantum mechanics in that way. But this is a perfect proof of what we are saying, because I came here. And I said,
1:08:09
for clinical neuroscience, but you and some of your co-participants as well, were not perhaps shy to raise their hand. They say, no, no, but wait a moment. What about quantum mechanics? Yes,
1:08:24
perfect. I don't know the answer for that. But if we follow pop art, everything is falsifiable, not also ones are white. And as we said, with Newtonian physics, there is an adding of, I mean,
1:08:37
that you have 10 grams plus 20 grams, 30 grams And then relativity, it's ugly. Yes. I mean. And there you have a fantastic field to explore. Yeah, and maybe sometimes, yeah, because I ask
1:08:53
that because in the near future, the quantum world may enter the medicine and may have an impact. So we may need to
1:09:03
find a new way to think in that way. So, yeah, sorry, go ahead, yeah. No, I am dreading you because I am excited. You are proving that what we are saying today is true Yeah,
1:09:18
but there is a hole in this thing. What about the fantastic? Yeah, I just, I have one other thing. I usually think of the first principle thinking, which is a type of like in physics, like for
1:09:35
example, the gastric ulcer on the bacteria. So there is two things, but I am not thinking about them as two entity I will reduce them like what the back is. I can't do like, for example, excrete
1:09:48
toxins. These toxins can attack what in the gaseous, which is the mucousers. Then this sequelae of reduction that can lead to better exoplanation, like is that valid within this kind of like logic
1:10:04
you are exploring here just to be sure? Yes, yes, because if you create as we mentioned before, A should not be just one center, you know, bacteria, rain, like one sentence. That's what in
1:10:18
the textbooks of logic they appear simple like that, and sometimes they sound too simple. No, if you have A can be exactly a large body of explanation that you are saying, summarize, you know,
1:10:30
say if we can summarize or synthesize or reduce everything to one molecule, imagine a molecule that damages the mucosa, responsible, then we can, yes,
1:10:45
Yeah, yeah, that's it, yeah. Thank you.
1:10:51
To answer a question as well. This is, I mean, I like to finish this thing with the pictures of the children. I mean, pediatric neurosurgeon. And these are a group of children in Argentina. And
1:11:11
why I like this picture a lot is because, yeah, there are funny kids there. But this kid is wearing the t-shirt of my team, of River Plate.
1:11:24
And so for that reason, I choose that picture. I mean, I have that picture and I use it many other times. And,
1:11:34
you know, in Argentina, there is a strong rivalry in soccer team. Maybe you have the same in Iraq between River and Boca.
1:11:46
river and bokeh, river and bokeh. And for me, this was a fantastic picture of a river. I mean, come on, it's a kid with a river t-shirt. Until my wife said to me, yeah, but this one is
1:11:57
wearing the t-shirt of bokeh, and I didn't see it.
1:12:04
So that is the induction. What a cute picture of Argentinian kids. Well, maybe not that much, no. Maybe I will edit the bokeh out next time And that's what we do in daily basis in the medicine,
1:12:19
believe me, we do that in medicine also.
1:12:24
Anyway, so I think that we are done today. I will
1:12:30
stop the share of the screen like that. And let me see. Can I have a comment, sir?
1:12:38
What is it? Oh, can I have a comment? Oh, you're, you're please, please, please Yeah.
1:12:45
First of all, we are I think in the middle of the course and the fourth lecture out of around seven. So I should say thank you from all of us to you. And we are all noticing the modification, the
1:13:03
adjustment and how the lectures and the principal are customized to the, let's say to the Middle East culture And we really appreciate that this is something we would like to say. And my next point
1:13:20
is that for the black swan And I think my first paper ever was
1:13:31
our knowledge with the residency of neurosurgery that melanoma is one of the most aggressive secondary metastasis to the brain at that time is that patient lives frame already. for months and it's
1:13:46
one of the shortest life expectancy. And during residency, one of the patients, we don't know, he has ICH, we evacuate the intracranial hematoma and it's not a real hematoma, it's a different
1:14:03
color, it's very dark. So we send it biopsy
1:14:08
and retrospective, we know later after the surgery that the patient has history of skin lesion and they know melanoma and a lot of lesion and
1:14:19
the chest and abdomen, they didn't tell us. And so we did the surgery on emergency basis, we don't know, it was melanoma. And the patient already like three years after diagnosis and she's good.
1:14:34
And then I follow the patient personally because it's definitely against anything I understand at that time, especially with no knowledge of research she's report, I have no idea at all. So at some
1:14:48
point, I have followed with the patient family and they say that she's good up to 40 years and then she died from renal failure. So I think this is the next one. At that time, I feel, is that
1:15:03
correct? That I should say something about that. And I put just a simple report It's, I think, if I look at it now, it's a funny report, just multiple pictures of the evidence
1:15:20
with the dates and a report on the case. And I send it to one of my friends who is known in research and we published this in 2017, I think. And
1:15:33
that was the start that, okay, this means that there are always exceptions and those exceptions can be here. There is nothing to prevent us from. following our patient and without disregarding the
1:15:50
truth or let's say without disregarding the standards, but if we observe something out of norm, we should be keen enough and prepared enough to follow that way because it may lead to something. And
1:16:07
for me, it all start from that time that, oh, I'm starting to questioning everything and looking to every patient in different way. And in our related example, one of our team colleague, Dr.
1:16:24
Aufa, she's now a surgeon. At some point during residency, she came, she was 30 of her residency and just say to me that I didn't notice that any paper suggesting what will be the best in your
1:16:40
anatomy resources for neurosurgeon to study. I didn't found anything about it, even article, even website description. So I told her, if that true, just check it again. She check it, I check
1:16:56
it also. And yeah, this means that all the generation didn't notice that there is nothing, no investigation about what are. And it was a very simple and basic question If you are a neurosurgeon or
1:17:13
you want to be a neurosurgeon, simple question, what should I read regarding to the anatomy? And we end with a like a cross-sectional study and we published a paper about the potential neuroanatomy
1:17:29
resources for neurosurgeon. And it was the one like a very unique paper. If you search neuroanatomy for neurosurgery, you'll find this paper as paper one So I think, yeah, based on Like I'm
1:17:44
saying like continuation of your stories within our like very limited experience. But questioning the principle that should be standard to everybody is important. But definitely after getting a full
1:18:01
idea about the standards just to be
1:18:07
within like a patient treatment direction at the end Otherwise, anybody can suggest just tap hazard ideas, which is not the best way, especially while we are teaching students. So I'm just telling
1:18:23
them that try to combine both study the article, study well the topic and the usual treatment and the successful current treatment. And as Dr. Lazar advised you through the course question every
1:18:38
step because you may be find something in you just to combine both. And yeah, thank you. No, thank you. And just to emphasize, I'm sure knowing you, a question politely, as not all the swans
1:18:54
are white. You wanna say, are only white size or black swan? No, not white, just think about it, you know? Not all patients with melanoma, the eyes. Not all, yeah, we noticed the lack of a
1:19:09
textbook, not to me, here we present our modest proposal, yeah, in that way, and that way, yes, absolutely.
1:19:18
So, I let you go, no? Because it's midnight over there where you are.
1:19:24
Yeah, in Iraq there. Yeah, midnight and go back.
1:19:31
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1:19:36
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