When Not to Trust Science (December 9, 2014)

You have probably realized by now that I think people's health and medical decisions need to be based not on what is usually done, or even what seems logical to do, but on what the available evidence suggests is the best course of action. It is so easy to fool oneself into believing or disbelieving things simply because those ideas are comfortable or familiar. I don't want ever to do that myself. So I choose to trust a profession that is chock-full of well-educated people  (scientists) who are using reliable tools to measure and draw trustworthy conclusions about the nature of the world that we all share (science). I don't even have to trust them that much, because I expect that they will gleefully pounce on each other’s mistakes for personal advantage and keep each other, and the work, honest that way. Science is how we obtain evidence that is more reliable than we can get from just our limited experience and it’s a tool that we can use to climb out of the hole that lack of knowledge and superstition would otherwise trap us in. Or that's how I think about it, anyway.

So I’m all for science and the evidence it provides us. The problem is, though, few of us can look at the raw data underpinning most scientific issues and actually make sense of it. When you start getting into the more technical aspects of health and medicine, even people educated in that field have to rely on others once they get outside their specialty. So there are at least a couple of interpreters, usually several, between us and the actual data. And that is where Experts and Trust start becoming important.  

There is a huge amount of trust implicit in something as simple as driving to work, never mind as complicated as the reliability and meaning of the research underlying medical knowledge. And we don't have a lot of trust in scientists. The common thinking is that that is because scientists come across as cold and unfeeling and they need an image makeover for us to start trusting them. This is nonsense, of course. It's because practically every week there's a news story that tells us that something a scientist once told us was true has turned out to be false. In the field of medicine, there's probably a major event of that nature about every month. So when to trust science, or not?

- Start by never taking a headline at face value. News thrives on drama and controversy. There may be a large, reliable body of evidence that points in one direction, but if one crummy little study appears to say something different it will wind up splashed all over the news as though the heavens had just opened. That cheap little practice of the news media makes it look like there is a whole lot more doubt about many subjects (such as food and nutrition) than there really is.

- Be dubious of the information when the Expert you're talking to has a really strong personal interest in the subject under discussion. Someone who has just bought a $100,000 therapy machine is probably not the best person to talk to about whether you need that therapy or not.

- When the person talking about the science is not an expert on the subject, don't give them too much credence until you investigate further. Especially politicians. Why people believe politicians on any subject but politics is a mystery to me. (And why is it that an M.D. can write a book on ANYTHING and it gets published?)

- You might look at how complete the science is. Is there genuine confusion or lack of evidence for one side or the other? You can search “eating breakfast” if you want to see what I mean about this -- half the articles you pull up will be favorable, the other half will be unfavorable, and each one will have an expert in it telling you that this is the last word on the subject. You needn’t distrust the science here as much as just realize that you need a lot of evidence to be sure about something.

- Don’t trust science if it isn’t following its own rules. It doesn't matter how commonly something is done or how logical it seems to be, when it comes to treatments for medical problems we don't know whether or not it actually works unless it has been tested. Far fewer than half of medical procedures have been properly tested as to their efficacy and overall benefit. Doctors gave women hormones after menopause for DECADES based on no more than the assumption that female hormones were protective against heart disease. When someone actually took the time to investigate this treatment, it was immediately discarded and all you ladies who had unnecessary heart attacks in the meantime, well, sorry about that.

- A lot of "reporting" these days is actually just advertising paid for by the subject of the piece. American Airlines recently ran a series of articles on American cancer centers that were just that – without identifying them as such. I find this practice particularly disgusting. But it's very common, especially in local news.

And when you are making a decision about the legitimacy of something, be honest with yourself about your own motives. Good doctoring often involves telling people precisely what they do not want to hear. I once heard about a woman who searched far and wide until she found a doctor who smoked. Presumably she expected him not to pester her about her own smoking.

Evidence and the experts who evaluate it for us is a pretty big subject, and the closer you look at it the more disheartening it can be. There are good research papers that don’t get published because their conclusions run counter to prevailing thought. There is research that is never published at all because those who paid for it didn’t like what they found. And if no one has ever bothered to investigate something and get their data published, there's no evidence even to evaluate -- that was a problem with spinal manipulation for many, many years. And so forth.

There's no perfection possible here. But giving the science on a subject at least a look is better than the alternatives. Just keep your eyes open, seek reliable counsel, don’t fool yourself, and use your own judgment, always.

--dr. diane holmes
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