Though I saw it all around
Never thought I could be affected
Thought that we'd be the last to go
It is so strange the way things turn

Monday, June 6, 2011

The limits of science.

I think I've mentioned before that there are limits to science. It was a basic limit, that is if there is no study or data regarding a subject, science (typically) says it doesn't exist or isn't so. If the scientist being interviewed is generous, they'll go with the bland, "We can't speak to that because there is no data," answer. Both sound authoritative and because it is usually spoken by a person in a white lab coat, most people nod their heads sagaciously and swallow the pablum, and label the question in the "No" column.

However, it's complete bullshit.

While it feels we are in the "end times" and all is falling into ruin, people speak authoritatively like we have figured everything out and know a lot of what there is to know. We are in fact at the very beginning of scientific inquiry. As the quote goes, "The more we learn, the more we learn just how much more we need to learn."

Here's the thing, science is a process. Science is political. And many things are considered "scientific" when, in fact, they aren't "science" at all. All of those things put boundaries on science and all are critical faults. Here I will make the caveat that science is fabulous and certainly beats (hands down) faith based assumptions. However, you would be very surprised at just how much "science" out there are really faith based assumptions (carnivores feeling "remorse", the sexual reproduction of herd animals gong to the "biggest and strongest males"). There are the "frontiers" of science (this means, "nobody has ever really studied this" or "this issue isn't settled"). There is the "contradictory data" issue on both a macro and micro scale (of which climate deniers and intelligent design proponents like to use as proof that the theories they're going against are wrong, however what they point to are controversies over minutia, not evidence that contradicts the main theories). There are things that are beyond scientific inquiry (well, mostly things that you really can't do with science, such as "disprove God" or "prove a negative").

Science is a process of percentages. With the way the politics of science (internal to discipline areas) currently work, you really can't "prove" anything with one experiment anymore. If you read the papers, even if the evidence is overwhelming, the writer (typically the last name on the paper) will use the phrase, "seems highly likely, although it warrants more research," or something similar. Even though there is plenty of "established" science that was shown to be "true" because of only one experiment that was never repeated let alone replicated. Some of these are now being disproven as new researchers try to base new experiments using the data and conclusions of the past only to find their experiments go awry (because what they're basing their experiment on, the previously published material, turns out to have been incorrect). Not many places give grants to redo someone else's research. And if you can't get a grant, or secure some other funding, nothing is going to be done. And it's an embarrassment (not often discussed) about just how much "research" out there is bogus (either cooked data, bad procedure, or experiments that just weren't conducted). Then there is the politics of getting research grants (there's really very little unsponsored research going on that doesn't have any conflicts of interest, even if we ignore the basic, "make it so we get another grant" temptations). Add in the politicization of science in the realm of actual real politic, and things get screwy very fast.

Finally we get to things that look like science, but aren't really. They can have the minimal trappings of science (like "Ghost Hunters") or they can be cloaked in heavy-duty tin foil science, like modern medicine. Yes, I can hear you howling from here. Modern medicine, as a professor once commented to me, "is the best lies we know." Why, because as a working physician he saw many "well researched" conclusions overturned. And not all of them were because of "breakthrough science."

You might remember the recent discontinuation of the NIACIN trials, or the more disastrous hormone replacement therapy trials. You may also remember that these therapies weren't new drugs or new uses for the drugs. Not to mention the various drug recalls (with drugs being removed from the market because they not only didn't perform as their earlier trials, but the side effects were quite worse than originally shown). These make more sense when you understand the underlying mechanics of drug research (hint, the tests are set up to succeed by statistical probability). YOu may have also heard that the placebo effect has been increasing lately. You could chuckle, shrug and say, "Well, that just shows the healing power of positive thought." It's a common riposte that sounds like it explains the problem. It's completely wrong, though. While the brain is a wonder (the origin of "placebo" was the use of "morphine" that had actually run out, but the field doctor knew he had to do something, and many of the patients who got the placebo felt better), what the placebo effect shows is just how ineffective some medicine is.

This is not to be taken as a criticism of vaccinations or any other prophylactic medicine practices. We have good research that those work (we also have good research that says they're not 100% safe, but the societal benefit outweighs the costs) and that they don't lead directly to autism. So, if a doctor says "You should…" you should take that seriously and follow directions.

Now, this isn't to say that modern medicine isn't good for a whole lot of things. Like broken bones for example. However, in my own case, my orthopedic doctor, citing that there were no long term studies on the internal use of metals, had all my screws and plates removed. Many doctors will cite there's no research that shows such long term exposures to metals causes any risk and so, leave them in.

But what I really want to point you to is the documentary, Under Our Skin. It's about Lyme Disease, and specifically chronic Lyme disease. It exposes the politics of medicine and research, and how those two problems combine. It talks about how something as common as Lyme disease is still not diagnosed correctly. And it also talks about how the insurance companies are really driving the process (remember all that talk during the HCR debate about how government shouldn't get in-between you and your doctor and those of use pointed out that there was already a worse actor there, your insurance company?).

As someone who has seen first hand the devastating problem of doctors either "just not keeping up to date," "failing to keep an open mind," or "not seeing what was in front of them," It's maddening. The patient knows something is wrong, and because whatever it is doesn't fit the test for the first thing the doctor thinks of, it's written off as "just in their head." I can only tell you that this isn't the only disease that is treated this way. Notice just how large the "antidepressant" market is. Not all of those people taking those drugs are really depressed. They have a disease that is not diagnosed, but still fell "malaise", and so the default position for most doctors is, "You're depressed. Here, take some of these." Do I need to roll out the list (fibromyalgia - still considered to be all in your head, chemical sensitivity - still considered bogus in many places, pollution related cancers - just turn on the news to see how this is treated). Why is this happening? Money. Plain and simple. There are even well known diseases that doctors just don't diagnose.

Also, make sure you catch that the majority of cases of doctors being brought before their medical boards for review aren't brought there because of patient complaints. The majority are brought there by insurance companies.

Notice the one doctor (involved in setting the standards for treatment for Lyme disease) and his stance on anything that disrupts his conclusions. Scientists, real scientists, don't behave that way when there is no data. Real scientists will say, "We have no data one way or the other, we should research that." He says, "There's nothing to show that there is chronic Lyme disease." Even though there are patients right in front of him. Because, you know, it's all in their heads.

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