The Confusion of Science & Medical Research (Part II)

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In our last post we riffed off column in the New York Times titled "Medicine of the Move" (earlier titled "The Body Politic"), where Gail Collins opened with the statement: "sometimes you just want to tell the medical profession to make up its mind". Granted, we conceded, medicine and science can seem confusing. We described in Part I how medical profession recommendations come from science research, which the press can make appear contradictory. As an example, we showed differences between caffeine/diabetes research as presented in the media, compared to the research presented in the original source. We walked through different experimental protocols that would appear to show different results to the unpracticed reader. Finally, we emphasized that although headlines make ordinary science progress into "news" every day, a small research step reported in the "news" should not be confused with a public health recommendation.

As for public health recommendations, yes, doctors change them. But is it that the medical profession that "can't make up it's mind"? After all, medical advice comes from science research studies. Maybe it's scientists who can't make up their minds? In this post I'll explain why people puzzle me when they often complain that doctors/scientists "can't make up their minds". Secondly, I'll explain why I believe this popular notion is actually dangerous.

Would the World Be Better if The Medical Profession Didn't Evolve?

My first point I'll pose in the form of a question -- would the complainers rather that science and medicine be static than dynamic? Lets take the subject of Collins' NYT column that dealt with hormone therapy for female menopause.

First, lets look briefly at medical history. Hormone therapy came of age in the 1960's, a half a century ago. For perspective, let's look at an accelerated time frame. A century ago, doctors didn't understand that bacteria caused food poisoning. Doctors who admitted patients for so-called "ptomaine poisoning" could wash out patients' mouths, insert tubes in their stomachs, feed them milk, and wring their hands as they watched people stricken with food-borne bacterial infections die. Fifty years later, things had progressed. By mid-century, scientists understood bacterial infections and how they could be treated with antibiotics.

Medicine in the 1950's and 1960's saw the advent of the polio vaccine, the development of ultrasound to see babies inside the womb, and treatment of chronic kidney failure by hemodialysis. In 1960 and 1961 scientists along the East Coast of the US learned that the Hepatitis A virus was caused by shellfish contaminated with raw sewage. In the 1950's and 1960's doctors made major advances in cardiac surgery so they could repair congenital heart defects in babies. Such repairs became feasible when doctors realized that they could use a patient's relative as a live "heart and lung machine". From that 'proof of concept' technology advanced to machines that could keep patients oxygenated during heart surgery. As you can imagine, the first "heart surgeries" were risky business, and are new procedures in every field of medicine, especially surgery. The 1950's and 1960's brought major improvements to medicine, but in fits and starts. Mid-century, post WWII was the era when hormone therapy became popular.

Who To Blame?

Based on recent findings about the risks associated with hormone therapy, women and doctors now hesitate before turning to hormone therapy. Collins, who developed breast cancer that she attributes to hormone therapy, ended her NYT column with this: "Actually, I don't blame anyone. Except maybe the guy who wrote that "Feminine Forever" book." She's referring to an early hormone therapy proponent and author, gynecologist Dr. Robert Wilson. Today, the book's title sounds suspiciously pseudo-medicine but it probably sounded different to women in the 1960's, half a century ago. At that time of "women's liberation", Wilson chastised the predominantly male medical community for being callous to women. A 1966 Time Magazine article described Mr. Wilson's complaints about doctors:

"physicians generally dismiss post-menopausal changes as part of the 'natural' aging process. Their attitude, [Dr. Wilson] suggests tartly, stems from the fact that "most doctors, being male, are themselves immune to the disease." As he sees it, the menopause is "castration," and [Wilson] asks whether his colleagues would tolerate so casually a similar fate in themselves.

So in the era of women's liberation, Wilson accused men as standing-by while women were one day bra-less free spirits, and the next day "castrated" at the youthful age of 50. Which is why in 1966, as Time Magazine wrote:

All over the U.S., women in their 40s and 50s are going to doctors and demanding "the pills that will keep me from growing old." Women in their 60s and over are asking for "pills to make me young again." In each case, what they are really asking for are doses of hormones to slow down or reduce the ravages of age.

Now, a half a century later, science studies are finally catching up with individual accounts and showing that some of the risks people had always worried about with hormone therapy could not be ignored. But for the last half a century some women got terrifying first hand knowledge of risks they probably had no had no idea they were assuming. Breast cancer is one of the most publicized concerns, with studies showing 8 in 10,000 women per year contract breast cancer who wouldn't have without hormone therapy. In addition, women who take estrogen and progestin risk more strokes, blood clots and urinary incontinence.

To be fair, there are associated decreases in the incidence of colorectal cancer and hip fractures with hormone therapy. Many women benefited and swore by hormone therapy. But the problem was, no woman nor her doctor could predict which risk vs. benefits bucket she might fall into. That's always the hardest part, predicting risk given very few knowns and a vast number of unknowns. Today scientists continue to do research in order to try to find a way that women can glean the benefits of hormone therapy but not incur the risks.

As hormone therapy fades in popularity it may seem intuitive to damn whoever made it popular. Perhaps hormone therapy was in part a cultural movement that's gone the way of hippies? Not quite. Half a century later, women's liberation is less of a cultural driving force in the United States, but women of all ages take take other risks, for instance with plastic surgery. Decades from now, this too might look silly. But now, there's all sorts of rational urging that not only to stay young looking, but to keep a job, to stay in the job market, women must stay looking youthful.

Moving away from the NYT column, if you want to cast blame, there lots of targets. Profit making companies -- pharmaceutical, insurance and media -- all distort public health knowledge. Much has been said about each of these industries. But people should just as well blame the human body for not making medical science easier and more predictable. Genetic variation assures that people can react differently to the same treatments. The same medication that cures one person, will do nothing for another, and in rare cases will kill another.

Many women never incurred any negative outcomes from hormone therapy. Scientists are still working to understand why. Doctor try to apply that knowledge for patients' health. Fortunately for all of us, scientists and doctors don't give up, therefore science and medicine continue to evolve. People who think change is a curse, who infer therefore that this progress is a curse should spend some time perusing old medical journals.

The Logic of Blaming Scientists

Medicine and science do change in half a century, true, and that's a good thing. But even if you're looking at science or medical progress over a short time span, does saying medicine/science can't make up its mind make sense?

Isn't it a little like saying "the press can't make up its mind"? After all, science research is almost always translated for the public by the press. So do "science columnists" like John Tierney at The New York Times behave in concert with journalists/data movers like Julian Assange at WikiLeaks? Can these journalists ("sources", to some) be lumped with TV personalities or "citizen journalists" at the Huffington Post? With twittering science journalism professors? Sure, you can clump together professionals if that feels convenient, but in an honest moment no one would compare the entire cohort of "scientists", "doctors", or even "journalists" to a school of ten thousand sardines flitting hither and thither through the sea until they expire in Santa Barbara harbor from depleting all available oxygen.

Just as absurd, the statement that science or medicine "can't make up its mind" presses the illogical notion that scientists collude in order to present the disparate or outlying findings that you immediately find looking across any subject's vast body of research. I'm sure scientists would love to be gifted with such inordinate non-existent powers over research grants, graduate student experiments, science publishing, reviewers, etc. in order to collude, but the universe is not so magical.

Clearly, these ideas about scientists' ignorance or malevolence do not make sense, but that does not stop their spread. And while the NYT lede was perhaps tongue in cheek, the very common sentiment that scientists can't tell what's really going on in all the conflicting research leads to more insidious behavior. This is our second point.

Fostering Dangerous Attitudes about Science and Medicine

Propagating the myth that scientists and doctors present "conflicting" results, and "can't make up their minds" leads citizens to exasperation with research. Few acknowledge how it's all filtered through the press. Fewer still peruse the even the summary, called an "abstract", of original studies, most of which are publicly available online (for instance health at Pubmed).

In this way, the commonly expressed sentiment that scientists change their minds can become in essence a self-serving excuse for apathy: 'How can I take care of my health when scientists and doctors can't even make up their minds?' As the subtitle of the NYT article puts it: "It's very difficult to be a civilian in the world of science." Oh, woe are we. But ironically, by blaming scientists/doctors, citizens resign themselves to fate and thus open themselves to manipulation.

So second to pointing out the fundamental essence of science and medicine that advances at a rapid pace, fortunately for us, I suggest that the myth that scientists can't make up their mind is insidiously destructive because it enables manipulation of the public in matters of science and medicine.

Take personal health. If people believe they are helpless, they're less likely to try and understand the science that effects them, less likely to do research, and less likely ask questions of doctors. Distrust of allopathic medicine can also lead people to ignore doctors, to turn to "woo-woo" theories, or to become susceptible to relentless pharmaceutical advertising and absurd press headlines aimed at readers. It's fine to criticize woo-woo science, as many scientist do, taking on homeopathy, acupuncture, anti-vax, chiropractic, chrystals, etc.; but scientists and critics are intellectually blinkered if they do that without acknowledging the anti-science industry that gives these sorts of "healers" their power.

Once people have fully accepted the premise that scientists and doctors "can't make up their minds" on health, it's a small step to convince them that science can't make up "it's mind" on anything else either.

Are climate scientists predicting an Ice Age or Global Warming cry shills for energy "business as usual" (BAU) such as fossil fuel lobbies? And now half the US population doesn't believe in climate change, a situation that doesn't bode well for any species. I simplify of course, people also choose not to believe in climate change because they don't see anything they can do about it. But often that learned helplessness starts with a false indictment of scientists. As in personal health, the false indictment that scientists really don't know anyway is self-serving because it breeds fatalistic apathy.

The apathy leads to further victimization by those who work most effectively when citizens don't pay to close attention. Not only do people believe they can't do anything about global warming, they justify their stance by saying the scientists don't know what's happening either. This becomes the perfect atmosphere for severe policy moves like the destruction of the EPA. Polluted air and water disproportionately effect the elderly, poor, and very young who can't protest, but in the end it will effect everyone. Propagating distrust in science by claiming science can't make up it's mind creates the perfect apathetic breeding ground for such radical policies.

To conclude, I heartily disagree with the idea the medicine or science can't make up it's mind. First, too often people confuse press headlines with medical advice derived from many research studies, each of which is only a building block to public health recommendations. As medical history shows, it's these changes, commonly called progress, that has expanded our lifespan (albeit with risks). It defies logic to say that scientists collude to create conflicting results. Most importantly, the popular idea that science or health professionals "can't make up their minds" feeds a learned helplessness that in turn opens citizens to further manipulation.

(Whose responsibility is it to make sure that people understand science research? In the end, it's of our responsibility. Unlike many others, I don't agree that it's up to the scientists' to educate the general public. But that's the subject of another post.)

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1 Pointing out that the media can distort the actual results of studies for the sake of a headline, we asked why, for instance, the lead author would be quoted in this Science Daily study saying "We have known for many years that people with or at risk of Type 2 diabetes should limit their caffeine intake", when the author's actual science journal study (M.-S. Beaudoin, L. E. Robinson, T. E. Graham. An Oral Lipid Challenge and Acute Intake of Caffeinated Coffee Additively Decrease Glucose Tolerance in Healthy Men. Journal of Nutrition, 2011; 141 (4): 574 DOI: 10.3945/jn.110.132761) reported correctly that studies have found a "negative correlation between long- term coffee consumption and type 2 diabetes risks"? See? Study says one thing, news report on the study says another.

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great post..

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