SCIENTIFIC SUPERSTITIONS.
Posted by bmhegde on 1
“I don’t give them hell. I just tell the truth and they think it is hell.”
Harry S. Truman.
The word superstition is used here to mean reverence for, or belief in, principles which are not worthy of worship. Scientific temper is to have curiosity about anything and everything and not accepting anything without getting into the core of the matter, using accepted methods of scrutiny. One must have this scientific temper in any field of human endeavor lest humankind should fall back into the valley of illogicalism. However, in science today there are many areas where blind faith in certain principles has led us astray and landed science in a mess. I shall confine this article to medical science in particular but it could be extended to other areas as well. Why is science in this mess today?
I am reminded of the story of the Tower of Babel. In the Book of Genesis this story stands out for its moral value. When the people of Babel wanted to erect a tower to reach heaven, God, in His wisdom, must have been concerned. He planned to give the people of Babel different languages so that they could not understand each other and the Tower never got built consequently. This is where science is today. We have divided scientific activity into narrower and narrower specialties that today a physicist does not understand a chemist and biologist does not understand either of them.
Medical science is in a total mess since it began riding piggyback on the natural sciences since the 12th Century AD. It is still deep into the conventional laws of deterministic predictability in a dynamic human system that does not follow these rules even for a second. We have been therefore, predicting the unpredictable future of the hapless patients and making life miserable for them.1 Anything that divides eventually disappears, avers one of the Laws of Thermodynamics. Unless specialists come together to understand each other science has no future so long as we have different languages for different people like the people of the city of Babel.
This above statement has been more than ratified by the recent studies in the west. The IOM report in the US has shown that doctors and hospitals are the third important cause of death and the Adverse Drug Reactions (ADR) as the fourth cause!2 Another European study of five countries showed that where there are more doctors there is less health and vice versa. Recent doctors’ strike in Israel brought the death and disability rates remarkably down during the strike period only to return to their original levels after the doctors withdrew the strike and went back to work.3 Interventions in healthy people to avoid later catastrophes have been disastrous in the long run.
Risk factor hypothesis:
This has been the biggest myth in medicine. Consider the sites designated to clean up hazardous waste. Calculated risk of someone’s chance of getting cancer from those sites is I in 10,000 or more. The risk is so small that it would take a study of at least 500 million people (twice the US population) to prove such a small risk. One can never be proved right or wrong in this situation. Some of the more famous unprovable risks are the ones that are flaunted on the public day in and day out! We are only assessing relative risks and not absolute risk anyway.4 In this scenario anything could be a risk factor. Wearing a brassiere all day long could be a great risk for breast cancer! Biological plausibility is the only certainty in this area. However, one of the greatest worries for the lay people (who can read these health magazines) is this silly risk factor hypothesis, a superstition indeed.
Statistical significance:
P-value indicates the probability that the statistical association is a fluke. The smaller the p-value the better. If it is below 0.05 there is a less than 5% chance of your association being a fluke. 95% chance that it is true! 95% confidence interval.4 However, the p-value is immutable. If it is above 0.05 also one could manage to fix it for showing better results. There are methods to do that: we will not go into that here.
Controlled studies:
Claimed to be the last best thing to have happened to medical research, the controlled studies have been the biggest superstition of all times. We compare two cohorts of humans matched for body mass index and a few known phenotypic characters. The cohorts are therefore supposed to be identical. Human being is not just the phenotype only. Whole man is genotype, phenotype and consciousness. Unless one gets the total picture, time evolution can never be predicted. The latter does not depend on partial knowledge of the initial state of the organism, but on the whole knowledge. Under the circumstances controlled studies have no meaning at all.5 To cap it, time evolution might not keep pace with the minor changes made to the initial state of the organism, as time evolves. This is the main reason why most, if not all drugs, in the long run have done more damage than good to patients, emerging as the fourth important cause of death in the US.
Blind extrapolation:
Extrapolating controlled study data to patients is another superstition. There are no controlled studies of many drugs used in combination, but in reality patients get many tablets together. Controlled studies have been done for short periods of time-rarely up to five years, but patients take drugs for decades. Worse still is extrapolating animal studies to humans. Although we have burnt our fingers many a time in the past the superstition continues unabated.6 One of the provocations to write this article is a patient that I saw yesterday. A middle aged physician’s wife, this hapless lady was on 28 tablets and daily insulin injections in addition! I do not think that there has been a controlled study of this kind of combination anywhere in the world to date. God only should know what these drugs do in tandem and to one another in this kind of an environment.
Faith in Drug Company sponsored research:
Two recent books by eminent authors in the US reiterated what I had been writing for decades. Marcia Angell, the former editor in chief of the New England Journal of Medicine in her celebrated book The Truth About Drug Companies published by Random House and John Abramson in his classic Overdo$ed America published by Harper Collins, exposed the dangerous scenario of the drug company fraud. Still better is the book Health Myths Exposed by Shane Ellison. Despite the many glaring instances of fraud, drugs are still being marketed by companies under various garbs. Doctors are being bought over by these companies and the so called “thought leaders” on the company pay role are the real culprits in making the gullible public and the medical profession to believe in their wisdom to pontificate.
Research Fraud:
Disease clusters and Texas sharpshooters, data dredging, mix-master technique, otherwise called meta-analysis, baked biological plausibility, picking the right animal species to show positive results, maximizing the dose, in addition to the final doctoring and sexing up data are all used regularly in medical research.4 Peer review is another one of those untested methods to authenticate one’s research data. I have not been able to understand how peer reviewing could be fool proof! Many of the reputed journals also have editorial policies that might assist in these processes. To cite one example, many a time any original study is accompanied by an editorial by a guest editor. Most, if not all, of these breed of wise people are on the pay role of the Drug Company that has funded the research in the first place! The new avatar of drug trials in the developing countries is another great fraud on the gullible public. These CROs are only brokers to get drugs studied in the developing countries to make huge profits for themselves.7 They entice doctors in those countries with relatively comfortable perks compared to their earning capacity in their positions otherwise. One could only imagine the results in this setting. Of course, the trial results are the property of the sponsoring company and are published by them.
In this background medical research becomes highly suspect. The most important facts remain to be discovered yet. With nearly forty thousand bio-medical journals in the field and new information coming out at a phenomenal pace of 7% per month, there have been very few, if any; refutative research data that could take knowledge forward in any area. Most of the data have been repetitive.8,9 I have not touched on the remedy for this serious illness although I have the remedy. That is for another article. May human kind remain happy in spite of the medical fraternity.
“If data have been cooked and the results plausible, there is no way peer review can catch the fraud.”
Arnold S. Relman.
Then editor-in-chief of New England Journal of Medicine in the Washington Post, May 16th, 1989.
BIBLIOGRAPHY.
1) Firth WJ, Chaos-predicting the unpredictable. BMJ 1991; 303: 1565-1568.
2) Starfield B. Is the US medicine best in the world? JAMA 2000; 284: 483-485.
3) Smith R. Doctors going on strike could be good for society. BMJ 2003; 326: 456.
4) Milloy S. Science without Sense. 1993. CATO Institute, Washington DC.
5) Hegde BM. To do or not to do. Jour. Indian Academy of Clin.Med 2002; 3(3): 236-239.
6) Packer M, Carver JR, Rodeheffer RJ, et.al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE research group. New Engl.J. Med. 1991; 325: 1468-1475.
7) Eaton L. Editor claims drug companies have a parasitic relationship with journals. BMJ 2005; 330: 9-10.
8) Altman K. The scandal of poor medical research. BMJ 1994; 308: 283-284.
9) Campbell EG, Louis KS, Blumenthal S, Looking the gift horse in the mouth. JAMA 1998; 279: 995-999.