Why I Don’t Believe In Science

Why I Don’t Believe In Science | THCB – By Michel Accad, MD – Feb 16, 2016

As a case in point, a few weeks ago the New England Journal of Medicine published the results of the SPRINT trial which had randomized patients with high blood pressure to one of two treatment protocols:

  1. high intensity therapy, to try to achieve a systolic blood pressure less than 120 mmHg, or
  2. low intensity treatment for a more modest reduction in blood pressure (less than 140 mmHg).

To the surprise of many, the trial was stopped early because the difference in mortality rates between the two groups was statistically strong enough to trigger an automatic termination.

High intensity was superior to low intensity, and continuing the trial could expose the low intensity treatment group to an excess risk of mortality if the trial kept going for another few years.

Luckily, SPRINT was a NIH-sponsored trial, so the usual suspicion that the results could have been rigged by profit-motivated pharmaceutical companies could not be raised. In many other ways (size, design, statistical methods, etc.) SPRINT seemed to follow some of the recommendations made by Ioannidis.

Nevertheless, many physicians seemed upset about the results, and some of their reactions seemed to betray biases of their own.

As soon as the abrupt trial termination was announced, Eric Topol and Harlan Krumholz, two academic leaders in cardiology, wrote an Op Ed pages in the New York Times in which they demanded that all patient-level data be made promptly available for review by the scientific community. Being NIH-sponsored, it seemed, was not good enough to satisfy the skeptics.

A trial can tell us that on average certain types of patients may do better with this treatment than that one, but a trial can tell us nothing about how the patient at hand will fare, and this patient invariably has certain characteristics that make him or her different from those patients enrolled in the trial. We are not clones, after all.

any physician worth the M.D. after their name have to use judgment to take care of patients, and clinical judgment is decidedly “unscientific.” After all, if we are allowed our own respective clinical judgments—and thankfully, so far, we are—there is no scientific explanation for any agreement or discrepancy among us. Judgments are decisions, not “discoveries.”

There is a cost to implementing new rules that must be added to an already horrendously expensive and lengthy clinical trial process, and if the aim is to get ever closer to scientific certainty, there is no end to the resources that could be employed to triple verify and vet everything that goes into a clinical trial

In fact, clinical research is extremely costly precisely because of perennial calls to make it “more rigorous” and more believable.

And these calls are not new: our healthcare system was born out of a desire to put snake oil salesmen out of business by making medicine ever more scientific.

But if that desire leads to a boundless commitment of resources and still remains unsatisfied, perhaps it’s time to reconsider its pre-suppositions.

Besides, I’m not sure that the academic community, whose living depends in large part on the conduct of research, is sufficiently impartial when it comes to determining the optimum cost of the scientific enterprise

In the comment section of a Health News Review blog post discussing the SPRINT trial, Mayo Clinic physician-scientist Victor Montori—a very well-respected champion of patient-centered medicine and “shared decision-making”—expressed a wish that “new pressure be applied to prevent [early trial termination] from ever happening again.”

Alan Cassels, a health policy researcher and the author of the article, agreed with Montori and added that “we should not cheer the decision to stop the trial, and sprint to erroneous conclusions about what it all means.” I have read similar remarks made in other venues online or in print.

not only do they demonstrate circular reasoning in regards to scientific validity (termination rules are precisely put in place to remove human bias), but they also implicitly express the view that seeking scientific clarity is worth risking some lives.

This, in my mind is a troubling position to take, and it points to a more general danger, which is that if we believe in science too strongly, we may end up not believing in patients anymore

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7 thoughts on “Why I Don’t Believe In Science

  1. Red Lawhern

    When a trial reveals statistically significant and highly negative outcomes such as morality rates – which the blood pressure study did – then most physicians would recognize early termination of the trial as ethically required. One cannot kill patients with impunity simply because we want to refine a protocol or dose regime.

    What is missing from this picture, however, is follow-up study to evaluate the mechanisms that caused the result. Regrettably often, studies are terminated by pharmaceutical companies without reporting negative findings — or even outright suppressing such results — if the findings don’t validate the drugs which the companies wish to sell. Disclosure of patient data from failed trials could be a positive step in learning what produced this undesired outcome, and avoiding it in trials of other protocols.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Yes, the lack of any further action to understand such a drastic negative result is truly a waste of all the work that was done. But the statements of those that protested the trial’s ending are frightening. They don’t see patients, they see lab rats.

      Re: “One cannot kill patients with impunity simply because we want to refine a protocol or dose regime.”

      This is exactly what they are doing by imposing opioid restrictions without a valid scientific study (or even scientific reasoning) to prove any benefit of this drastic medical turnaround.

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  2. leejcaroll

    Sems to be specious reasoning at best. The penultimate of this position is that each clinical “trial” is based on a sample of one. You then get no new treatments tested or medications or research

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      There is some truth in what you say: when a patient is actually treated with whatever method is statistically advantageous, they are a trial of one. When one treatment is shown to be statistically better than others, this does not apply to an individual.

      In general, population statistics don’t apply to individuals. No matter how many times a coin comes up “heads”, the next individual coin flip still has just a 50-50 chance of coming up heads.

      I hate it when I’m forced to submit to a treatment that has shown 90% effectiveness just because the doctor is enamored of such good odds, instead of really thinking about how this might apply to my individual situation.

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  3. Kathy C

    This is the problem. Science and whatever they do in so much “Research” are two different things. This is the unfortunate attitude of many Physicians. Their belief that their opinions are more important than observable fact. Most of them are fed their “opinions” in Journals, HMO Guidelines, and subtle Pharma Advertising. It is only rarely that Physicians are even aware of the outcome of their Patients. That information is effectively censored. We are now in the Post Fact Era, since Physicians don’t have the facts, they are inconvenient, they can rely on Opinion.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      When “research” so often contradicts itself it’s hard to keep believing :-)

      Still, even research isn’t truth, it’s exploration. Statistical analysis help find some general “statistical truth”, but we cannot apply such statistical results to all patients because the results are only for the “average” patient (if the sample is large enough and truly random).

      However, we have to remember that this “average patient” has one breast and one testicle, just like the “average US family size” is 3.14 people.

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      1. leejcaroll

        If I read the article correctly and I did read it fast I was not referring to statistically advantageous. It sounds as tough they think research is unc=necessary and doc should pick and choose whatever floats is boat. Research certainly points the way to an idea off what will and will not, may or may not work, potential side effects etc rather then a hotgun approach.
        My last surgery was 100% experimental, only the 13th in world and most of them did not have it for the reason and area of the brain that I did. There were no other options available for me but a doctor surgeon shouldnt be deciding to do use non tested treatments because they dont believe in science. It is like going to the forest without any knowledge of mushrooms and keeping your fingers crossed the one yu coose to eat won;t be poisonous. A little research, a little knowledge helps to mae decissions and point you in the right direction,

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