I want to believe: Prior beliefs influence judgments about the effectiveness of both alternative and scientific medicine

Previous research suggests that people may develop stronger causal illusions when the existence of a causal relationship is consistent with their prior beliefs. In the present study, we hypothesized that prior pseudoscientific beliefs will influence judgments about the effectiveness of both alternative medicine and scientific medicine. Participants (N = 98) were exposed to an adaptation of the standard causal illusion task in which they had to judge whether two fictitious treatments, one described as conventional medicine and the other as alternative medicine, could heal the crises caused by two different syndromes. Since both treatments were completely ineffective, those believing that any of the two medicines worked were exhibiting a causal illusion. Participants also responded to the Pseudoscience Endorsement Scale (PES) and some questions about trust in alternative therapies that were taken from the Survey on the Social Perception of Science and Technology conducted by FECYT. The results replicated the causal illusion effect and extended them by revealing an interaction between the prior pseudoscientific beliefs and the scientific/pseudoscientific status of the fictitious treatment. Individuals reporting stronger pseudoscientific beliefs were more vulnerable to the illusion in both scenarios, whereas participants with low adherence to pseudoscientific beliefs seemed to be more resistant to the illusion in the alternative medicine scenario. Alternative medicine refers to a wide range of health practices not included in the healthcare system and not considered conventional or scientific medicine (World Health Organization, 2022). A common feature of alternative therapies is the lack of scientific evidence on their effectiveness, with some popular examples being homeopathy (Hawke et al., 2018; Peckham et al., 2019) and reiki (Zimpel et al., 2020). Therefore, they often can be considered pseudoscientific (i.e., practices or beliefs that are presented as scientific but are unsupported by scientific evidence; Fasce and Picó, 2019). Understanding why some people rely on alternative medicine despite this lack of evidence is relevant, since its usage can pose a threat to a person’s health (Freckelton, 2012; Hellmuth et al., 2019; Lilienfeld, 2007), either by replacing evidence-based treatments (Chang et al., 2006; Johnson et al., 2018a, 2018b; Mujar et al., 2017) or by reducing their effectiveness (Awortwe et al., 2018). In this research, we will assume that people assess the effectiveness of a given treatment (whether scientific or alternative) by estimating the causal link between the treatment (potential cause) and symptom relief (outcome). To achieve this, people can resort to various information sources, but they could certainly use their own experience of covariation between the treatment and the symptoms. However, biases can occur in this process. In particular, the causal illusion is the systematic error of perceiving a causal link between unrelated events that happen to occur in time proximity (Matute et al., 2015). This cognitive bias could explain why people sometimes judge that completely ineffective treatments cause health benefits (Matute et al., 2011), particularly when both the administration of the treatment (i.e., the cause) and the relief of the symptoms (i.e., the outcome) occur with high frequency (Allan et al., 2005; Hannah and Beneteau, 2009; Musca et al., 2010; Perales et al., 2005; Vadillo et al., 2010). Although the causal illusion is subject to variations in the probability with which the potential cause and the outcome occur, and hence most theoretical analyses of the phenomenon have focused on how people acquire contingency information (e.g., Matute et al., 2019), the participant’s prior beliefs could also play a role, and this will be the focus of the current paper. In fact, influence of prior beliefs seems common in other cognitive biases that enable humans to protect their worldviews. A good example is the classical phenomenon of belief bias (Evans et al., 1983; Klauer et al., 2000; Markovits and Nantel, 1989). This consists of people’s tendency to accept the conclusion of a deductive inference based on their prior knowledge and beliefs rather than on the logical validity of the arguments. For example, the syllogism ‘All birds can fly. Eagles can fly. Therefore, eagles are birds’ is invalid because the conclusion does not follow from the premises, but people would often judge it as valid just because the conclusion seems in line with their previous knowledge. There is a specific form of belief bias known as ‘motivated reasoning’ (Trippas et al., 2015), in which people exhibit a strong preference or motivation to arrive at a particular conclusion when they are making an inference (Kunda, 1990). Thus, individuals draw the conclusion they want to believe from the available evidence. To do this, people tend to dismiss information that is incongruent with prior beliefs and focus excessively on evidence that supports prior conceptions, which resembles the popular confirmation bias (Oswald and Grosjean, 2004). Additionally, some evidence points out that motivated reasoning can specifically affect causal inferences (Kahan et al., 2017), particularly when people learn about cause–effect relationships from their own experience (Caddick and Rottman, 2021). Thus, if these cognitive biases show the effect of prior beliefs, it should not be surprising that causal illusions operate in a similar way. In fact, some experimental evidence suggests that this is the case. For example, Blanco et al. (2018) found that political ideology could modulate causal illusion so that the resulting inference fits previous beliefs. In particular, the results from their experiments suggest that participants developed a causal illusion selectively to favor the conclusions that they were more inclined to believe from the beginning. Thus, we predict that prior beliefs about science and pseudoscience could also bias causal inferences about treatments and their health outcomes. More specifically, we suggest that, when people attempt to assess the effectiveness of a pseudoscientific or scientific medical treatment, their causal inferences may be biased to suit their prior beliefs and attitudes about both types of treatments. In line with this idea, a recent study by Torres et al. (2020) explicitly examined the relationship between causal illusion in the laboratory and belief in pseudoscience. These authors designed a causal illusion task with a pseudoscience-framed scenario: participants had to decide whether an infusion made up of an Amazonian plant (i.e., a fictitious natural remedy that mimicked the characteristics of alternative medicine) was effective at alleviating headache. They found that participants who held stronger pseudoscientific beliefs (assessed by means of a questionnaire) showed a greater degree of causal illusion in their experiment, overestimating the ability of the herbal tea to alleviate the headache. Importantly, note that this experiment only contained one cover story, framed in a pseudoscientific scenario. We argue that the results observed by Torres et al. (2020) have two possible interpretations: the first is that people who believed in pseudoscience were more prone to causal illusion in general, regardless of the cover story of the task; the second, based on the effect observed by Blanco et al. (2018) in the context of political ideology, is that the illusion is produced to confirm previous beliefs, that is, those participants who had a positive attitude toward alternative medicine were more inclined to believe that the infusion was working to heal the headache, and causal illusion developed to favor this conclusion. Given that only one pseudoscientific scenario was used in Torres et al.’s experiment, it is impossible to distinguish between the two interpretations. Thus, further research is necessary to analyze how individual differences in pseudoscientific beliefs modulate the intensity of causal illusion, and whether this modulation interacts with the scenario so that prior beliefs are reinforced. To sum up, the present research aims to fill this gap by assessing the participants’ attitude toward pseudoscience, and then presenting an experimental task in which participants are asked to judge the effectiveness of two fictitious medical treatments: one presented as conventional/scientific, and the other one as alternative/pseudoscientific. None of these treatments were causally related to recovery. Our main hypothesis is that the intensity of the observed causal illusion will depend on the interaction between previous beliefs about pseudoscience and the current type of medicine presented. Specifically, we expect that: • Participants with less positive previous beliefs about pseudoscience will develop weaker illusions in the pseudoscientific scenario than in the scientific scenario. For those participants, the conclusion that an alternative medicine is working is not very credible according to their prior beliefs. • Participants with more positive beliefs about pseudoscience could either show the opposite pattern (so that they find more believable the conclusion that the pseudoscientific medicine works than the conclusion that the scientific medicine works), which would be consistent with the studies by Blanco et al. (2018) on political ideology, or, alternatively, they could show similar levels of (strong) causal illusion for both treatments, which would suggest that pseudoscientific beliefs are associated with stronger causal illusions in general, as has been previously suggested (Torres et al., 2020)Grant PID2021-126320NB-I00 from the Agencia Estatal de Investigación of the Spanish GovernmentGrant IT1696-22 from the Basque Governmen

An Uncommon Cause of Dyspnea: Usefulness of Multimodality Cardiac Imaging

Tomografia computada; Falta d'alè; EcografiaComputed tomography; Shortness of breath; UltrasoundTomografía computarizada; Falta de aliento; EcografíaPericardial lipomas are very uncommon benign primary cardiac tumors. We describe the case of a patient with symptomatic large pericardial mass who presented with heart failure. Multimodality cardiac imaging helped us in the diagnosis of this unusual entity. (Level of Difficulty: Intermediate.

Renal Function Impact in the Prognostic Value of Galectin-3 in Acute Heart Failure

[Abstract] Introduction: Galectin-3 (Gal-3) is an inflammatory marker associated with the development and progression of heart failure (HF). A close relationship between Gal-3 levels and renal function has been observed, but data on their interaction in patients with acute HF (AHF) are scarce. We aim to assess the prognostic relationship between renal function and Gal-3 during an AHF episode. Materials and methods: This is an observational, prospective, multicenter registry of patients hospitalized for AHF. Patients were divided into two groups according to estimated glomerular filtration rate (eGFR): preserved renal function (eGFR ≥ 60 mL/min/1.73 m2) and renal dysfunction (eGFR <60 mL/min/1.73 m2). Cox regression analysis was performed to evaluate the association between Gal-3 and 12-month mortality. Results: We included 1,201 patients in whom Gal-3 values were assessed at admission. The median value of Gal-3 in our population was 23.2 ng/mL (17.3-32.1). Gal-3 showed a negative correlation with eGFR (rho = -0.51; p < 0.001). Gal-3 concentrations were associated with higher mortality risk in the multivariate analysis after adjusting for eGFR and other prognostic variables [HR = 1.010 (95%-CI: 1.001-1.018); p = 0.038]. However, the prognostic value of Gal-3 was restricted to patients with renal dysfunction [HR = 1.010 (95%-CI: 1.001-1.019), p = 0.033] with optimal cutoff point of 31.5 ng/mL, with no prognostic value in the group with preserved renal function [HR = 0.990 (95%-CI: 0.964-1.017); p = 0.472]. Conclusions: Gal-3 is a marker of high mortality in patients with acute HF and renal dysfunction. Renal function influences the prognostic value of Gal-3 levels, which should be adjusted by eGFR for a correct interpretation.Grant No. RD06-0003-0000 Grant No. RD12/0042/000

Short- and Long-Term Prognosis of Patients With Takotsubo Syndrome Based on Different Triggers: Importance of the Physical Nature

Background Takotsubo syndrome (TTS) is an acute reversible heart condition initially believed to represent a benign pathology attributable to its self-limiting clinical course; however, little is known about its prognosis based on different triggers. This study compared short- and long-term outcomes between TTS based on different triggers, focusing on various physical triggering events. Methods and Results We analyzed patients with a definitive TTS diagnosis recruited for the Spanish National Registry on TTS (RETAKO [Registry on Takotsubo Syndrome]). Short- and long-term outcomes were compared between different groups according to triggering factors. A total of 939 patients were included. An emotional trigger was detected in 340 patients (36.2%), a physical trigger in 293 patients (31.2%), and none could be identified in 306 patients (32.6%). The main physical triggers observed were infections (30.7%), followed by surgical procedures (22.5%), physical activities (18.4%), episodes of severe hypoxia (18.4%), and neurological events (9.9%). TTS triggered by physical factors showed higher mortality in the short and long term, and within this group, patients whose physical trigger was hypoxia were those who had a worse prognosis, in addition to being triggered by physical factors, including age >70 years, diabetes mellitus, left ventricular eyection fraction <30% and shock on admission, and increased long-term mortality risk. Conclusions TTS triggered by physical factors could present a worse prognosis in terms of mortality. Under the TTS label, there could be as yet undiscovered very different clinical profiles, whose differentiation could lead to individual better management, and therefore the perception of TTS as having a benign prognosis should be generally ruled out

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Estrategia para la implementación y ejecución de alternativas para la diversificación productiva de grupos, organizaciones y comunidades del Área Marina de Pesca Responsable (AMPR) Paquera-Tambor, Golfo de Nicoya, Puntarenas, Costa Rica.

Programa Interdisciplinario Costero-IDESPO-UNA. Proyecto Gestión Comunitaria áreas marinas de pesca responsable Golfo de NicoyaEs de conocimiento que las personas pobladores de las comunidades costeras, específicamente del pacífico costarricense, dependen mayoritariamente de la actividad pesquera para la obtención de ingresos y solvencia de necesidades básica. La estrategia de alternativas de diversificación productiva se centra en organizaciones de diferentes actividades como: el turismo que es desarrollado por la Asociación de Buzos de Paquera (ABUZPA), la venta de insumos agropecuarios a cargo de la Cooperativa de Productores Agrícolas Industriales de Guayaba Taiwanesa (COOPEPROGUATA), la comercialización de productos marinos a cargo de la Cooperativa de Productores Marinos Responsables (COOPEPROMAR) y servicios de alimentación en restaurante quien lo ejecutará ASOTAMBOR. Por medio de los insumos teórico - metodológicos de la investigación acción participativa (IAP), se generó un proceso de construcción y acompañamiento a través de la comunicación y el diálogo entre las partes, logrando así la vinculación necesaria para llevar un proceso de investigación fructífero, participativo y con la población de interés.It is known that the people living in coastal communities, specifically the Costa Rican Pacific, depend mostly on fishing for income and solving basic needs. The strategy of productive diversification alternatives focuses on organizations of different activities such as: tourism that is developed by the Paquera Divers Association (ABUZPA), the sale of agricultural supplies by the Cooperativa de Productores Agrícolas Industriales de Guayaba Taiwanesa ( COOPEPROGUATA), the commercialization of marine products in charge of the Cooperative of Responsible Marine Producers (COOPEPROMAR) and restaurant food services that will be executed by ASOTAMBOR. Through the theoretical - methodological inputs of participatory action research (PAR), a process of construction and support was generated through communication and dialogue between the parties, thus achieving the necessary link to carry out a fruitful research process, participatory and with the population of interest.Universidad Nacional, Costa RicaInstituto de Estudios Sociales en Población (IDESPO-UNA)Escuela de Planificación y Promoción Social-UN

Impact of time of intervention in patients with NSTEMI. The IMPACT-TIMING-GO trial design

Introduction and objectives: The optimal time to perform a diagnostic coronary angiography in patients admitted due to non- ST-segment elevation acute coronary syndrome (NSTEACS) and start pretreatment with dual antiplatelet therapy is controversial. Our study aims to identify the current diagnostic and therapeutic approach, and clinical progression of patients with NSTEACS in our country. Methods: The IMPACT-TIMING-GO trial (Impact of time of intervention in patients with myocardial infarction with non-ST segment elevation. Management and outcomes) is a national, observational, prospective, and multicenter registry that will include consecutive patients from 24 Spanish centers with a clinical diagnosis of NSTEACS treated with diagnostic coronary angiography and with present unstable or causal atherosclerotic coronary artery disease. The study primary endpoint is to assess the level of compliance to clinical practice guidelines in patients admitted due to NSTEACS undergoing coronary angiography in Spain, describe the use of antithrombotic treatment prior to cardiac catheterization, and register the time elapsed until it is performed. Major adverse cardiovascular events will also be described like all-cause mortality, non-fatal myocardial infarction and non-fatal stroke, and the rate of major bleeding according to the BARC (Bleeding Academic Research Consortium) scale at 1- and 3-year follow-up. Results: This study will provide more information on the impact of different early management strategies in patients admitted with NSTEACS in Spain, and the degree of implementation of current recommendations into the routine clinical practice. It will also provide information on these patients' baseline and clinical characteristics. Conclusions: This is the first prospective study conducted in Spain that will be reporting on the early therapeutic strategies-both pharmacological and interventional-implemented in our country in patients with NSTEACS after the publication of the 2020 European guidelines, and on the clinical short- and long-term outcomes of these patients