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Saturday, April 03, 2004As Dr. Drummond Rennie, deputy editor of The Journal of the American Medical Association (JAMA), puts it, 'This is all about bypassing science. Medicine is becoming a sort of Cloud Cuckoo Land, where doctors don't know what papers they can trust in the journals, and the public doesn't know what to believe.' But isn't science a bastion of truth? Such statements reflect the ideal of science, not the reality, says Dr. Marcia Angell, former editor in chief of The New England Journal of Medicine. Public protestations aside, she says, "Clinicians know privately that results can be jiggered. You can design studies to come out the way you want them to. You can control what data you look at, control the analysis, and then shade your interpretation of the results." Even the most careful research can be fraught with murky results that require sifting and weighing, a measure of judgment that the researcher hopes will bring him closer to the truth. Was this patient's headache caused by the antibiotic you gave her, or does she have a history of migraines? Is that patient's depression lifting because of the drug you are testing, or because a kindly doctor is actually listening to him? But doesn't the peer review process keep everyone honest and insure that only scientifically sound papers get published? When researchers submit papers to a journal, the editor has little choice but to trust the authors have employed a ruthless skepticism when viewing their own results, that they have bent over backwards to minimize self-delusion. Editors and peer reviewers can ferret out sloppy reasoning, look at how an author has designed and executed a study, and correct faulty statistics, but as Angell remarked, "We don't put bamboo slivers under their nails. If they wanted to lie, they could lie." But, as we've seen with the recent MMR controversy, it isn't just corporate money and patent deals that drive the baser scientific instincts. Even studies funded completely by government or universities can be tainted by a researcher's agenda. If you've spent you're entire career arguing that A causes B, you're not going to be eager to publish data that says otherwise. This is why "peer reviewed journals" have such a cache of influence. The peer review process is supposed to weed out the bad science from the good science, to reign in author enthusiasm and unsound conclusions. But in reality, it doesn't. My husband, who in his academic days did peer review, explains it like this: Rather than giving submitted papers to a broad range of general experts in a field for review, they are given to a handful of specialized experts in the whatever field the paper is in. So, for example, a paper on the effect of radiation on man in the moon marigolds wouldn't be given to a broad panel of botanists, physicists, and biologists, but to a group of scientists whose only interest is radiation and marigolds. And within very specialized fields, most of the researchers know each other. Some will love the paper just because it's written by someone they like or don't want to offend, and others will savage it because it's written by someone they don't like - or because the conclusions don't agree with their own work. An example of the former is the recent paper in JAMA that turned the most frequent causes of death from diseases into sins. One of its authors was the head of the CDC. Now, tell me, who in the public health community is going to tell Julie Gerberding that her science is flawed? No one. It takes an outsider. None of this is new, of course. A scientist has to believe in his work in order to be motivated to do it. And the best of them have a passion for it. But even the most concrete of sciences can be influenced by observational bias, and passion can get in the way of reason, even among scientists. We, the public, have to remember that, and not treat every finding published in journals, no matter how respected, as the unimpeachable truth. (And the press needs to do the same.) UPDATE: One of the members of the President's Bioethics Council notes that in the case of the council, it's the scientists who are most agenda driven: Scientists are no less drawn to power, and have no fewer agendas, than others. Indeed, years from now, when the full story of the council's work can be adequately told, I suspect it will be clear that ideological conformity has been sought at least as fervently by scientists as by any other group in our society. posted by Sydney on 4/03/2004 01:48:00 PM 0 comments 0 Comments: |
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