Sunday, 19 February 2017

The slow, sloooow march of science

Today's blog from our Founder Robin Daly examines very closely the role of the 'scientist' in medical outcomes

Science is defined as ‘systematic knowledge of the physical or material world gained through observation and experimentation’. Sounds straightforward enough, but in the hands of humans with complex and poorly perceived motivations it can become translated into a dystopian but powerful worldview that makes little sense, but that has the power to harm very many people.

Ideally a scientist has an endlessly enquiring mind and is always convinced of how little he knows and how much more there is to be found out. In practice, however, the stance of science is all too often 

  • they used to think they knew 
  • but they were wrong 
  • now we know
This is a perpetual state of arrogance and ignorance, driven by a deep unacknowledged fear of the unknown and the uncertainties of life. While this is a fear shared by most humans, often science is used as a particularly effective shield to provide the illusion of security. In medicine, for example, this can manifest as the brilliant surgeon, supremely confident in his or her abilities and knowledge, who sweeps around the ward devastating one vulnerable patient after another, due to his or her utter disconnectedness from the realities of being human.

And as for ‘what’ is known, this tends to be what was taught to them at an early age, and that they will often cling to for dear life, against all the odds, often for a lifetime. Continuous Professional Development is an attempt to counter this destructive inertia, and I’m sure it has helped somewhat, but it is a very far cry from being driven to learn by burning intellectual curiosity. There’s a lot of truth in the commonly quoted observation that the real controlling factor over the rate of change in medicine is the working lifespan of doctors - you have to wait for one lot to die for any substantial new scientific view to be embraced.

Einstein - by anyone’s standards a ‘proper’ scientist - described this tragic state of affairs: “In the temple of science are many mansions, and various indeed are they that dwell therein and the motives that have led them thither. Many take to science out of a joyful sense of superior intellectual power; science is their own special sport to which they look for vivid experience and the satisfaction of ambition; many others are to be found in the temple who have offered the products of their brains on this altar for purely utilitarian purposes. Were an angel of the Lord to come and drive all the people belonging to these two categories out of the temple, the assemblage would be seriously depleted, but there would still be some men, of both present and past times, left inside.”1

More sinister than these very ‘human’ tendencies towards security, ambition, wealth and power are the forces that use them to their advantage. Here I am referring to business. Corporations have a very different raison d’ĂȘtre to medicine. They are there, first and foremost, to make money, not to save lives and not to make people healthy. If you manufacture patented pharmaceutical drugs, then you want the medical world to stay right on message with a credo that goes something like:

o   a drug is the answer to most health issues
o   drugs are safe and effective
o   any natural, unpatentable product is dangerous quackery
o   it is enormously expensive to make drugs so they have to cost an awful lot
o   drugs that are out of patent are of no interest or use - newer is always better
o   there are no simple, cheap solutions

and so on. Corporations have a very clear and well-documented understanding of the lack of true scientists in medicine (those rare beings who are more interested in what’s true than in their own comfort or advantage) and they use it mercilessly to maximise sales. Most doctors still believe that pharmaceuticals have little or no influence on prescribing habits, but science shows otherwise. Professor Peter Gotzsche2 in his shocking exposĂ© of the pharmaceutical industry - Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare - makes clear the morally bankrupt methods and deadly consequences that characterise the business of medicine. Pharmaceutical corporations are using any and every method they believe they can get away with to keep medics ‘on message’, to keep them, at the very least, buying, and preferably endorsing and promoting their products. Using the tried and tested twin prongs of fear and desire, they incentivise medical staff looking for power, wealth, recognition and status and encourage fear of exclusion, ridicule, and loss of status for the sin of non-conformity. This is hardly the ideal climate for genuine scientific progress. But then business cares little for progress, only for profit.

To give just one small personal experience of the consequences of this situation: You would reasonably hope that the leading surgeon at a top London hospital would have achieved that status through his skills, his scientific rigour and his consequential ‘cutting edge’ knowledge. Following the amputation of my daughter’s leg due to a recurrence of cancer, he had her on ‘the latest’ in pain management for such situations - Oxycontin. My daughter then experienced marked symptoms, between doses and during the period when the dose was being reduced. We had no idea if these were symptoms of cancer or of treatment. So we asked the ‘expert’, who breezily responded that it couldn’t be the medication as, despite being an opiate, it didn’t have any side effects or withdrawal symptoms. 

A little while later, out of desperation to help our daughter, we consulted the internet. All you needed to do was to pop the word ‘Oxycontin’ into Google and ‘boom’ - there it was: reams of posts and articles from people about the exact, unacknowledged side-effects my daughter was suffering.

How could a top surgeon have got it so wrong? How could someone clearly so intelligent act in such a blind and stupid way? Well it all came out in the news eventually: the pharmaceutical sales reps had been instructed to simply tell the medics that it had no side effects. That’s literally all it took! No science required. The profession was so thoroughly ‘on message’ that scientific scrutiny and the interests of patients had long ago been dispensed with. This is a small example of the sort of dystopian ‘science’ I referred to at the outset.

Of course it has always been thus. What is fairly new is our ability, as the public, to check up on what is going on, via the internet. Doctors have up to now enjoyed unjustified levels of public trust, but fortunately the days of carte blanch acceptance of their ‘expertise’ is waning and their real allegiances are increasingly exposed. If doctors don’t start changing their ways very soon, experiences such the one I described above, or bogus dietary advice based upon zero training or knowledge’ will have them languishing at the bottom end of the ‘trust tables’ along with bankers and politicians. Blandly pronouncing that there is ‘no evidence’ for anything that they don’t understand or that isn’t a drug, as a way to justify ridiculing and dismissing it makes them look increasingly stupid to a public often better informed about the evidence than they are.

Tragically the charity sector all too often lines up dutifully behind business interests as well. Simplistic health messages and ‘health myths’ that are winners for the food and pharmaceutical industries become fixed charity dogma, propelled forward by the imperatives of industry’s bottom line, long after any shred of science that once supported the initiative has evaporated. And then we have to endure the painful process of damage limitation: an ‘authoritative’ organisation that is supposed to have the public interest at its heart - but that has allowed itself to become ridiculous by dogmatically adhering to superceded ‘scientific truths’ - desperately scrabbling around for ingenious ways to refresh their dogma without losing too much face. It’s embarrassing, and the health cost paid by the public for this kind of ‘science’ is appalling. Tragically, you see evidence of this  malaise in many of the major charities, and you only need to look to their sources of funding and at which industries they habitually recruit their top executives from, to understand why.

Successive governments - also prey to the allure of almost limitless money and power exuding from industry, not to mention the threats to take their riches elsewhere if they suffer too much scrutiny or regulation - have been cripplingly slow to realise that to entrust the progress of healthcare to business is a fool’s game, since business has no intention to make us well. It profits from our disease, and if halting the progress of science is what it takes to make more money, that’s what will be happening. We urgently need a UK ‘Bernie Sanders’  to start telling it like it is, and to finally dispel the one massive and self-evident healthcare myth - that corporations care about our health and well-being. They never have, and asking them to is a clear case of putting the fox in charge of the hens.

1 Address at Physical Society, Berlin (1918), for Max Planck’s 60th birthday
2  ISBN-10: 1846198844  ISBN-13: 978-1846198847

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