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    Cape Ann Skeptics think there are more questions than answers

    Dr. Richard Sagall spoke about medical overdiagnosis and misdiagnosis at a recent meeting.
    Lisa Poole for the Boston Globe
    Dr. Richard Sagall spoke about medical overdiagnosis and misdiagnosis at a recent meeting.

    To live is to question.

    Critical thought prompts “why?” and “how?” and pushing back against prevailing opinion. It’s brought us the concept of the spherical earth, prompted us to explore above our heads, below our feet, and beyond the horizon, and made legendary figures of Galileo and Copernicus, Einstein and his brilliant modern counterpart, the British physicist Stephen Hawking.

    “It makes for a much more fulfilling life when you’re honest about things,” said Dr. Richard Sagall, cofounder of Cape Ann Skeptics, which urges its members to question and probe, examine and hypothesize. “It gives you a better appreciation of what you know and what you don’t know, and how to evaluate claims.”


    “Skepticism,” as the group defines it, is not about judgmental scoffing or raised-eyebrow condescension. Rather, it’s more of a philosophy: looking deeper, querying, trying to ascertain the real truths — or untruths — of a matter. It’s not cynicism, it’s not contrarianism; it’s rational, critical, and scientific thinking.

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    “When people hear the word ‘skeptic,’ there’s a negative connotation,” said Bob Bowles, a computer software engineer from Gloucester who attends the group’s monthly meetings. “It just means ‘curious.’ ”

    Sagall, a retired medical doctor from Gloucester, agreed, acknowledging that we all have biases and blank spots. The group doesn’t like to use the term “debunking”: Instead, members seek to “prove” or “disprove.”

    “It promotes thinking about things, not just accepting what you hear,” said Elizabeth Thomas, a retired computer programmer living in Gloucester. “People might think it’s the same as cynicism, but it’s not, it’s evaluating the evidence.”

    Skeptic groups abound across the world — from Texas to California to London — inspired by such celebrated question-askers as Canadian magician James Randi, Richard Dawkins, and the nonprofit Skeptics Society  — among many others.


    Cape Ann Skeptics has Dawkins’s most famous quote on its homepage: “By all means let’s be open-minded, but not so open-minded that our brains drop out.”

    The Cape Ann group held its first gathering in September 2010, and usually attracts 30 to 40 people to its monthly discussions.

    Points of debate have included voodoo, vampires, Santa Claus, simulated reality, free will, psychological matters, Internet security, surveillance, economics, numerous medical topics, even the many myths surrounding Coca-Cola.

    Only two topics are typically avoided, as at any civil dinner party: religion and politics.

    “It’s an opportunity for like-minded people to get together and have a discussion that they might not have otherwise,” said Sagall, who worked in family medicine and occupational medicine, and now runs the nonprofit NeedyMeds,  which provides assistance to people who can’t afford their medications and health care costs. “One of the things you learn going to skeptic meetings is how much you don’t know.”


    Bowles said he likes being exposed to new ideas. Before, he might simply have accepted things he heard or read without question. But now, he’s prompted to dig, noting that our brains are cluttered with so much information — some of it true, some of it not — and every day we’re bombarded with more and more “tiny nuggets” — sound bites, propaganda, and marketing — when the real story is “more complicated and interesting.”

    ‘One of the things you learn going to skeptic meetings is how much you don’t know.’

    “It broadens your view of the world around you,” he said.

    Of course, the whole idea is to have fun with it. Good-natured heckling and pot-stirring are encouraged, as is something known as “kittle pitchering,” an 18th-century term defined as a “jocular method of hobbling or bothering a troublesome teller of long stories,” by pummeling them with questions or objections, so as to distract them from settling into a “storytelling groove.”

    While the crowd at a recent Tuesday night session didn’t go quite that far, they were a boisterous group: laughing, joking, indulging in red and white wine, pizza, and rich Italian dishes, and crackling with questions. Roughly 45 men and women — most age 40 and up — crammed into a back room at La Trattoria and Pizzeria on Gloucester’s Main Street to hear Sagall’s talk: “Are you really sick? Overdiagnosis, misdiagnosis, and the natural course of disease.”

    Proudly brandishing a button declaring, “Skeptics: Think about it!” Sagall explained the difference between “subjective complaints,” or symptoms (such as soreness, depression, or pain), and the more measurable “objective findings” (a broken bone or a lump found during a mammogram). He also discussed the various types of tests — screening, diagnostic, predictive — and noted that doctors have to be careful interpreting them.

    “Medicine is an art, as much as a science,” he said. You “never treat a test, you treat a patient.”

    Keeping in mind the natural course of disease is also important, he emphasized. For instance, 90 percent of people with back pain will get better in 90 days, “no matter what you do.” He also spoke of the harm of overdiagnosis, which can result in unnecessary costs and anxiety, and inappropriate treatment.

    Ultimately, he encouraged more “patient empowerment,” and acknowledged that “doctors are not always right.”

    “Any questions?” he asked when he was done.

    “A thousand,” a voice in the crowd quipped.

    Someone suggested that overdiagnosis is a failure of the medical education system; another wondered whether it was a consumer protection issue; while someone else pointed out that it underscores how important it is to take control of your health and know your own body.

    The discussion also turned to what some felt was the “scam” of healthy cholesterol levels; the effectiveness of flu shots; the philosophical issue of placebos; pharmaceutical “need and greed”; the money in clinical testing that lures in the vulnerable; second opinions (Sagall pointed out that, almost all of the time, people will go with opinion “B”); and, ultimately, whether attitude affects recovery.

    Sagall thinks no, but he was rebutted by a woman who pointed to “The Anatomy of Hope,” written by Jerome Groopman, which explores how that emotion could have a role in the outcome of an illness.

    “I really disagree with what you’re saying,” she noted as she leaned back in her seat and folded her arms.

    Sagall shrugged and smiled. “That’s what we’re about here.”

    Taryn Plumb can be reached at