Previous: The Second Step Towards Immortality
I've had the following conversation with my girlfriend lately:
A: "Let's vaccinate our kid."
B: "But I've heard that vaccination can cause autism!"
A: "It's a hoax. There's no scientific evidence for the claim. Use scientific method. Read the related papers."
B: "But I've searched for the papers on the Internet and I've found one that claims that vaccination causes autism."
A: "You've got the wrong one. There are others that prove there's no correlation between vaccination and autism."
B: "How am I supposed to know which one is right and which is wrong?"
A: "Look for the peer review."
B: "Huh?"
A: "OK. Right, that's beyond what you can do. Check then whether the paper was published in a respected journal. These enforce peer review as a matter of policy."
B: "How do I know which one is respected?"
A: "Well, you can have a look at the journal's impact factor. It's not an exact measure of quality but the ones with high impact factors are likely to have rigorous policies with respect to peer review."
B: "How do I know what is the impact factor of a particular journal?"
A: "Impact factors are calculated from numbers of citations. These are published annualy by Thomson Reuters…"
B: "So you are saying that I should trust Reuters rather than the neighbor of my cousin's boss, who said that his daughter became autistic after being vaccinated?"
Got the morale? Unless you are a scientist and unless you are researching an issue from your narrow specialisation, the scientific method is based on trust. You are asked to believe. Same as in alternative medicine. Or in a religion. If you are a common person, there's no much conceptual difference between visiting a doctor and visiting your local shaman or a faith healer.
The above has non-trivial consequences for the scientific method. Scientific method explicitly aims to avoid faith and use measurement and experimentation in its stead. Asking for trust in the scientific discourse signalises a problem. And the only way to address it is to admit that minutiae of academic publishing (and distribution of scientific knowledge in general) however arbitrary and insignificant they may seem to be are in fact an integral part of the scientific method.
An obvious example: Sokal hoax. Physicist Alan Sokal have written an scientific article permeated with most obvious scientific nonsense and deliberate vagueness and managed to have it published in a scientific journal. You may consider the whole affair to be just poking fun at social scientists. However, there's a different point of view where the whole thing is a dead serious attempt at pointing at a flaw in the scientific method. As an extra bonus, the attempt was performed as an actual real-world experiment.
Less obvious example: The current fight between the scientists and the academic publishers. The whole thing looks like a economic, or maybe an political, struggle. However, there's a fully different point of view, where we are actually dealing with a broken scientific method and the fighting we see is a deliberate rational effort to fix it.
However, what I would like to focus on in this article is distribution of the scientific knowledge to a common person rather than to the scientists. And remember: Even if you are a rocket scientist, you are a commoner from the point of view of medical science. Thus, I don't want to talk about delivering scientific knowledge to 99% but rather about delivering it to everyone except to a select handful that happens to be at home in particular micro-specialisation.
To begin with, common people today generally do understand that science is good for them. Even if they believe in astrology, they still ask for science-based treatment at the hospital when they get ill. Even if they believe that the ancient civilisations had spiritual knowledge surpassing everything we know today they still use computers and mobile phones.
The real problem the common person faces is how to distinguish actual evidence-based scientific knowledge from different scams that are ever more often disguised as science or, for what it's worth, "alternative" science.
As demonstrated by the dialogue above, asking a non-scientist to research the scientific papers is not going to fly. People don't have enough time and background knowledge to do that. Moreover, they don't understand the scientific method (including the politics of academic publishing) well enough to reason about what they read. The only real option for them is either to trust or not to trust.
Thus, we need trusted people who serve as "ambassadors of scientific method". And in the case of medicine this role is occupied by doctors.
So, when you contract cold, you go to the doctor and you BELIEVE that the pill he prescribes won't hurt you and that it will actually help you. Asking a doctor for help is poor man's scientific method.
The question, of course, is why do you trust the doctor? Well, because the profession is regulated by the state and the doctor obtains his license only after finishing a school (where he is taught scientific method along with any specific knowledge needed in his field of expertise), having some actual hands-on experience and taking the Hippocratic oath.
Following the same argument as above, it can be seen that the process of licensing doctors is not only a regulatory issue, it's also an integral part of the scientific method.
And same as with academic publishing, the process is broken in different ways. Consider homeopathy. Today, it's common that a licensed doctor prescribes a homeopathic medicine, which is scientifically known to be ineffective. What can the poor man infer from that? Either the doctor is incompetent in which case he shouldn't have finished the school at all. Or he is corrupt, i.e. paid by pharmaceutical companies to prescribe ineffectual drugs, in which case he's violating the Hippocratic oath. In both cases his license should be revoked by the state. Yet, the state's own healthcare system sponsors homeopathic drugs in some cases! That being the case, how is the common man supposed to believe that the doctor is a trustable representative of a scientific method? For all he knows, next time he may be prescribed, according to ancient chinese medicine, to drink mercury to purify the body.
I could have ended the essay here, however, there are things about homeopathy that are almost entertaining, so let me make a little digression.
First of all, homeopathic drugs are pure water, which makes them harmless. Compare that to other snake oil medicines which may be straighforwardly harmful (for example, intoxicants may be added to the drug to make it addictive). I am serious here, not sarcastic: Homeopathic drugs, given the very nature of homeopathic theory, are pure water and thus are guaranteed to be harmless. As long as they replace other harmful pseudo-medicines, the net effect is positive. It only becomes evil when used as a replacement for actual scientifically proven treatment.
Second, I've heard that some doctors prescribe homeopathics instead of placebo. That sounds like a neat trick given that all the PR about homeopathics can make the patient confident about the drug and thus increase the placebo effect.
On the other hand, I recall I've read about a study that showed that placebo effect kicks in even it the subject is aware that he is administered placebo! When you think about it a bit, it can in fact make sense: You know that you are on placebo but you also know about placebo effect. Thus you expect your condition to improve which is sufficient for placebo effect to take place. If that's true, even those aware that homeopathy is a sham can benefit from it. However, at the same time, if it's true, all the homeopathics can be replaced by a single generic drug called "Placebo" and everthing would work as well — without breaking the trust in the doctors as representatives of the scientific method.
To get back to the original topic of this essay, we, as scientists and rationalists should make our best to present the issues of distribution of scientific knowledge (academic publishing, licensing of doctors etc.) as part of scientific rather than political discourse. If the political discourse everyone is going to aim for a political compromise. In scientific discourse, on the other hand, it's clear that there are good solutions and bad solutions. That we can quantify them, test them in experimental manner and either accept or reject them depending on the body of evidence collected during the experiments.
Martin Sústrik, Dec 31st, 2013
Previous: The Second Step Towards Immortality
http://www.bmj.com/content/321/7259/471
"The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo."
see "Bad Pharma" and TRUST …
Ben Goldacre: What doctors don't know about the drugs they prescribe
http://www.ted.com/talks/lang/en/ben_goldacre_what_doctors_don_t_know_about_the_drugs_they_prescribe.html
A nice talk about publication bias against negative results. It is an example of a problem that is commonly understood as a political one ("bad pharma") rather than scientific one ("sloppy methodology").
I believe we should strive for the latter.
"The methodology was flawed," is much stronger and actionable complaint than "the company that performed the trial is evil."
I guess you have a master's/doctor's degree in computer science.
I dropped out of a graduate school before admission and never learned a proper scientific method.
Yes, I have a master's degree. I never finished my PhD. But now that I think of it, the scientifc method as such was taught as part of optional curriculum (philosophy of science or such). Which means tthat people can get their master's degree without being directly confronted with the scientific method. Too bad.
Does the fallout from that ever goes away? I'm still dealing with disappointed parents…
You really can't even trust the "respected" or "impactful" scientific journals. Global Warming anyone?
"Got the morale?"
It's "moral".
some vaccine critics publications:
Do aluminum vaccine adjuvants contribute to the rising prevalence of autism?
Published by Elsevier Inc. ; http://www.omsj.org/reports/tomljenovic%202011.pdf
Lupus (2012) 21, 223–230 :
Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations
http://www.vaccineliberationarmy.com/wp-content/uploads/2012/01/LTShaw-Lupus-2012-Mechanism-of-adjuvant-toxicity-in-pediatric-populations.pdf
Annals of Medicine, 2011; Early Online, 1–12
Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?
http://dropbox.curry.com/ShowNotesArchive/2012/01/NA-382-2012-02-12/Assets/Vaccine$/Annals%20of%20Medicine%20HPV.pdf
Current Medicinal Chemistry, 2011, 18, 2630-2637
Aluminum Vaccine Adjuvants: Are they Safe?
http://vaccinexchange.files.wordpress.com/2011/05/tomljenovic_shaw-cmc-published2.pdf
and other problem
Harvard University:
Institutional Corruption and Pharmaceutical Policy
Journal of Law, Medicine and Ethics
Vol. 41, No. 3 (2013)
http://www.ethics.harvard.edu/lab/featured/325-jlme-symposium
favorite:
"Donald W. Light, Joel Lexchin, Jonathan J. Darrow, Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs"
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2282014
"Abstract:
Over the past 35 years, patients have suffered from a largely hidden epidemic of side effects from drugs that usually have few offsetting benefits. The pharmaceutical industry has corrupted the practice of medicine through its influence over what drugs are developed, how they are tested, and how medical knowledge is created. Since 1906, heavy commercial influence has compromised Congressional legislation to protect the public from unsafe drugs. The authorization of user fees in 1992 has turned drug companies into the FDA’s prime clients, deepening the regulatory and cultural capture of the agency. Industry has demanded shorter average review times and, with less time to thoroughly review evidence, increased hospitalizations and deaths have resulted. Meeting the needs of the drug companies has taken priority over meeting the needs of patients. Unless this corruption of regulatory intent is reversed, the situation will continue to deteriorate. We offer practical suggestions including: separating the funding of clinical trials from their conduct, analysis, and publication: independent FDA leadership; full public funding for all FDA activities; measures to discourage R&D on drugs with few if any new clinical benefits; and the creation of a National Drug Safety Board."
Nice piece, but I disagree that we necessarily need scientific "ambassadors". I'm not saying people should be their own doctors, those people are trained and have experience in their field, but there are important public decisions to be made, whereby voters should thoroughly understand the science to make an informed vote.
The basics of the scientific method, and it's results should be taught to the general public, especially as we move forward with more evidence-based policy-making.
We need to base our policies on realistic model of the world (where most people don't have time, resources or even will to dive into scientific discourse) rather than the idealistic one.
That's what I mean by making the policies themselves part of the scientific method.
Unfortunately, there's no good answer. The fact is that without personally knowing the scientists involved, there remains the possibility that they or their publishers were influenced by big money. There's no way for the common person to tell. I would however trust Canadian doctors over American ones, based on what seems a higher resistance to big pharma, corruption and better regulation. I for one believe the dogmatic push for flu shots is suspect and not good for otherwise healthy, young individuals.
Obviously, in post-scarcity societies, most people have a lot of time to research their problems. People with ample of time will be attracted to scientific methods to prove anything as rich europeans in the middle age were.
I guess post-scarcity societies will become common after 100~200 years.
Unless we have time for scientific methods or some internet researches, we have to trust some groups of people who've proven competent in solving problems of interests(like doctors and scientists).
I am afraid you are too optimistic. I believe we are long past the point when a single human being could exhaustively research all problems they encounter in their day-to-day life, even if they spend all their waking time trying to.
Of course, we are long past that point.
However, if people's children catch a lethal disease that's curable by some research, most people will be able to research the disease. I don't remember the specific case, but it happened in real life decades ago. Likewise, people will have time to focus on a few important problems in their lives. And this, I guess, will restore research culture that's lost after USA sent people to the moon.
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