Understanding Science: Science and Scientific Information
In a time of universal deceit, telling the truth is a revolutionary act.
George Orwell 1984
The distortion of evidence
The questions asked via my website indicate that understanding and discussion concerning the nature of scientific evidence, and how to acquire and assess it, is essential. No apology is required for the use of the above well-worn quotation, which will be known to many people. It is more apt now than ever. Anybody with awareness of the political dialogue, or should one say monologue? in North America, who does not appreciate that, must be suffering from terminal cerebral decrepitude. It does seem that we are drowning under a tidal wave of misinformation and, it should be called what it is, bullshit. Unadulterated bullshit.
It is distressingly clear that the average reader is challenged when it comes to an ability to exhibit critical analysis. There is a specific commentary about this, which some may find interesting and educative.
My series of commentaries contain plenty of negative and potentially depressing information and material about poor and biased science; but do not let that distract you from the fact that there is a lot of very good science being done, staggering and fascinating advances are being made: however, sorting the wheat from the chaff has become more and more difficult and improving one’s ability to do that is an valuable skill.
Think carefully about how you go about searching for information.
Learn to search, rather than searching to learn.
A “what-why” type question may be best addressed by a textbook or similar source. More specific clinical questions may be better addressed by database searches.
There is good discussion and useful information about such matters at Laika’s MedLibLog
“When you have a specific clinical question it may be better (especially for those new to the subject) to search “pre-filtered” sources, like National Guideline Clearinghouse, the TRIP-database and/or the Cochrane Library. This will save time, because studies have been selected and summarized for you.”
Generally speaking, unrefined searches for medical information on the Internet are very likely to require a great deal of time and effort and will produce so much biased mis-information that most people will be unable to ‘see the forest for the trees’. One has a certain sympathy for doctors who are bombarded with questions provoked by information acquired on the Internet.
My advice is this: start off by limiting your search to educational establishments, government websites, and “non-profit” organisations. It is easy to do this by using the Google advanced search feature that finds only certain suffixes, such as .edu or .gov or .org (search for <site:.edu>)
Think about the way to word your question for a Google search. Also think about the type and specificity of the question. Sometimes a general question about how to find what you want will be illuminating. For instance, the databases mentioned above, like the National guideline clearinghouse: there are many such attempts to gather information together under one umbrella. If you were looking for guidelines or recommendations about the treatment of a condition, say depression, a more general strategy might pay off. As well as looking directly for “depression guidelines” try also the query “how to find guidelines for medical treatment”. That leads you to various other similar collections of information, some of which are a little less Amero-centric than the national guideline clearinghouse, which is American.
Search for file types, particularly Adobe PDF files. People who post quality material on government and educational websites are most likely to do it in the form of PDF files, rather than word-processing documents. Therefore, limiting your search to PDF files is likely to produce a more refined and useful subset of results <filetype:.pdf>.
Remember that in most instances someone else will have already done the work for you, it’s just a question of finding it. For instance, if one was trying to find out quality information concerning diet, exercise, weight, and the health implications relating to heart disease, stroke, diabetes etc. one could start by searching for the recommendations and guidelines produced by the multitude of organisations and agencies with a finger in that pie (but be alert to hidden commercial influences). If your search has been limited to educational sites (site:.edu) then you will largely avoid blatantly partisan information produced by interested parties such as those who sell beef, cheese or sugar. From those documents it is possible to learn and extract the key terms and phrases that are used in that field. Also, note the prominent researchers that are quoted frequently in the bibliographies of such reports. One can then put those names into the appropriate databases to find whatever else they may have published more recently.
Also, note that when you put words into the Google search bar it immediately produces a list of related searches. Take notice of what appears on this list because it may be a clue about what keywords you might use; but do not let Google lead you by the nose.
The second database that has been more recently available is Google scholar which is an valuable resource and covers many scientific journals, and sources, that are not included in the NLM database.
Google scholar web search for heart/cardiac info, enter:-
filetype:.pdf site:.edu cardiac guideline
Which leads, along with much else, straight to a paper “Conflicts of Interest in Cardiovascular Clinical Practice Guidelines” (free pdf available!)
That paper contains a list of most of the significant guidelines produced recently. All done in a matter of less than a minute.
Then put the title into Google scholar and you get the result
“Conflicts of interest in cardiovascular clinical practice guidelines. TB Mendelson, M Meltzer, EG Campbell… – Archives of internal …, 2011 – ncbi.nlm.nih.gov
BACKGROUND: Clinical practice guidelines (CPGs) serve as standards of care in practice, quality improvement, and reimbursement. The extent of conflicts of interest (COIs) in cardiology guideline production has not been well studied. Herein, we describe the scope of COIs in CPGs. …
Cited by 4
Click on ‘cited by 4’ and you get a list of subsequent papers that have cited the above.
Looking at ‘cited by 4’ is a tactic I call a ‘forwards search’. If you put the title of a research paper into Google scholar, you will notice that it tells you how many other papers have cited that reference paper (as does PubMed).
Google will list all those papers. In other words, you are looking forwards in time from the publication you put in to see who has subsequently used it. That can be a handy way of finding good recent papers, which is more likely if the index paper is a good highly cited paper itself.
An example: using the National library of medicine database to find references to the papers by ‘Gillman’.
To find all my papers you would need to do 2 searches, Gillman, P and Gillman, K. the reason for that requirement is because such databases often do not take account of out-of-the-ordinary names, journals do not cope well with people like me who use their middle name not their first name (viz Peter Kenneth Gillman), therefore some journals log me Gillman, K, and some as Gillman, P and some as Gillman, P K: the database reflects that lack of and organisation, subtlety, and discrimination.
The author unique identification system called Orcid is not yet fully integrated into PubMed or used by all journals.
If you follow the above links to NLM you will see there is also a panel on the top right of the page titled ‘Filter your results’.
Clicking on those choices shows review papers only, or, useful, those with free PDFs available.
Also, you can usually get the DOI which is the digital object identifier unique code which you can use to enter into sci-hub, which will usually get you a free PDF of the paper: if you do this big-name publishers may threaten to prosecute you for copyright fraud, because their main interest is maintaining their profits at an extraordinarily high level — higher than almost any other fortune 500 companies. They have no interest in the democratic dissemination of scientific knowledge for the good of all.
It is worth going to journal websites to look for more information.
Aspects of research reliability
The pursuit of scientific truth is a noble endeavour, but it is subject to the influences, not always beneficial, of the various human failings that affect all aspects of life (cf. above, greed). An excellent book, almost a ‘must-read’ book for any scientist, by Professor Lewontin, erstwhile Agassiz professor of biology at Harvard, Biology as Ideology  explores, as an example, some false expectations, misconceptions and myths surrounding the human genome project.
Lewontin argues that the dominant social and economic forces in society strongly influence what scientists do and how they do it. He suggests the enormous amount of money [billions] put into the Human genome project had as much to do with politics as with scientific need and that it was probably a substantial mis-direction of funds and resources. Stephen Jay Gould described Lewontin as ‘the most brilliant scientist I know’ and said that his work embodies the very best in genetics, particularly in the way it debunks the reductionism of genetic determinism. That phrase, ‘the reductionism of genetic determinism’, for those not familiar with the lingo of logic and medicine, means the over-simplified idea that your genes determine what happens to you.
That idea is important because most of the genetic tests now being offered directly to the public are of limited validity or use. That is because the assumptions underlying them are reductionist and deterministic in a way which invalidates them. The genetic tests for the way we metabolise drugs are largely a waste of time. A sample of the literature from 2011 indicates that few informed researchers are claiming any great use for such tests at the moment: [2-9]. Enormous amounts of money are being spent on such tests.
A quick updating review of this field (Feb 2020) indicates little progress — that is what anyone who has understood what Lawnton was saying would expect because these things are much more complex than a simple genetic code reading. The following reviews and papers illustrate this point [10-18].
A key influence is that of capitalism in its various guises, some of which are quite antithetical to good science. That is nowhere better exemplified than by the extraordinary rise of the British publisher Robert Maxwell, who turbocharged scientific publishing, to his own incredible profit, in the 1960s: a recent article in the Guardian newspaper provides a useful historical perspective on the evolution of publishing
However, I do not think there is, yet, sufficient emphasis or coverage of the way massive increase of predatory publishing is degrading the scientific enterprise.
The rise of journals using the pay-to-publish model, that fit the definition of ‘predatory’ is one of the biggest threats to maintaining the quality of the scientific literature that has ever emerged. The number of journals that are that are bogus is quite staggering — most days I get a request to be on the board of editors, or be a keynote speaker at a conference, or publish a paper, that is connected with one of these fraudulent enterprises.
We need to teach students about, ‘learning to search, not searching to learn’.
Other recent refs [19-21].
Science is about continuing investigation; it has always been, and will always be, a work in progress. Almost nothing is right or wrong, or ‘proved’. Whenever you see the word ‘proved’* being used in science a red light should come on in your mind. In contrast, to ‘believe’ is to declare that no more investigation, questioning or doubt is required, merely acceptance of what is already stated to be true. Just accept it all and rest your tired and troubled mind!
* it is hard to resist commenting that most style guides suggest the use of ‘proved’; but the delightful inconsistency of the English language still adheres to the phrase ‘innocent until proven guilty.’
Science tries to make increasingly accurate representations of, and predictions about, the world, as interpreted through the observations that we are able to make, imperfect as those may be. Consider this, the group of people regarded as cranks and called the ‘flat-earthers’ are for many everyday purposes correct, they are only wrong about the earth being flat in a special and limited sense. In practice, we all operate on the assumption that the earth is flat for much of our everyday lives. The block of land on which a house rests, and its construction, all operate on the flat-earth principles. They do not take account of the curvature of the earth. It is only when considering things on a larger scale that the curvature of the earth becomes relevant and important.
Doing good medical research takes a lot of training, skill, and experience; but doctors’ training is largely towards doing clinical medicine not towards becoming experts in research methodology. However, doctors finish up running drug trials, often with little expert help, except from the drug company running the trial. Needless to say, the drug company have a keen interest in a favorable outcome. Having science funded by those with a financial interest in the outcome is always a bad idea; history tells us that, but we have not learned from history. The muddle that psycho-pharmacology research has demonstrated itself to be in the last 30 years is an eloquent testimony to that. It is important to understand that the so-called evidence that is relied on to allow drugs to be put on sale (i.e. to be approved by the MHRA FDA etc.) has not been replicated by any disinterested party.
It is also important to know that there are indications from a variety of sources that a predictor of whether a trial will demonstrate a favorable outcome for the drug being tested is ‘who paid for the study’ [22-27]. It has less to do with any medical considerations or efficacy. As Sismondo states, “[it] casts a shadow over much medical knowledge and practice” . Perhaps that is in the running for the under-statement of the decade?
There is complete reliance on drug company generated information: it is like going to buy a car and getting the second-hand car salesman to take one of his own cars for a test drive for you, and then to advise you if you should buy it. Few people are that trusting, nor should they be. Did I mention unfettered-free-market-capitalism and laissez-faire self-regulation?
Independent replication of results is an essential cornerstone of science. Other people must be able to copy your methodology and obtain the same result. It is only when that has been done, often several times, that we can be reasonably confident in those results. However, research in medicine almost always fails the criterion of independent replication. Worse still, even when particular pieces of research have been demonstrated to be unsatisfactory that is often not subsequently taken note of. A prominent and egregious example of that is the drug risperidone , one of the so-called — at least by the marketing division — “new generation” of “atypical” anti-psychotics. This will be a major contentious topic of the second decade of the millennium.
Efforts to curb the unscientific and pharmaceutical industry-centered-methodologies have continued since my original critical comments some years ago. This effort has produced no useful results and little improvement; strategies that bias publications about new drugs continue unabated . As I write this [Oct 2011], it is only a week or two ago that some drug companies announced they were withdrawing from funding psychotropic drug development. One imagines that the tightening up of the ethical and moral background on which they do their trials, and compulsory registration of trials, may have been a consideration [22, 29-31].
In any case, the evidence is that the monetary contribution of pharmaceutical companies towards research has always been rather smaller than they would have you believe. It constitutes only about 12% of the grand total, the rest coming, of course, from the public purse [22, 32, 33]. Their main activity has been in promoting their own drugs via the medium of sponsoring so-called ‘seeding trials’*. Since it is clear that the majority of those are seriously biased, that leaves their overall contribution looking unimpressive.
*Note: if you find something you are unsure about in the text remember to try Googling it. If you search “seeding trials” it will lead you to 1) a useful Wiki summary, and this-
Since there has been such an enormous preponderance of scientifically valueless work during my professional lifetime, it is difficult to take any view other than to consider drug company withdrawal from developing drugs and carrying out clinical research as being a good thing. Being obliged to read biased & deceitful research, in order to get some idea what the likely truth might be, has wasted an enormous proportion of my intellectual effort and professional time over the last three or four decades. I am not at all pleased about that. I could have done a lot more useful work if I had not had to wade through all of that deceit and misinformation in order to try and form a view about what was best for my patients .
Medical science is a difficult enterprise. It is easy to be critical of the science in medicine generally, and especially in psychiatry. However, that should not be taken, necessarily, to suggest that psychiatrists are sub-standard and poorly informed. They have been duped, like children in front of a magician. However, they are not children, and they have the duty of care towards their patients to think of, and the responsibility to act like critically-thinking independent adults. That may be where doctors have failed in the most spectacular way. They have been too trusting and uncritical, and they have assumed that everybody else has laudable motives, like many of them consider themselves to have.
So, be circumspect in what you conclude to be ‘true’. As Ioannidis has cogently argued ‘most published research findings are false’ . Caveat lector (reader beware).
It is now easier for non-medical and non-scientific people to access scientific information. This may come in many forms, from information on educational and government websites through to scientific papers that may be available free on the Internet. Many scientific journals require payment for reprints of articles (usually $25-$30 per item, even if it is only a letter), a few are free, and some journals make selected papers available free because they perceive it to be in their interests. For instance, my review of the anti-migraine drugs, triptans, and their ability to precipitate serotonin toxicity has just been made freely available on the journal website. The stated reason is because it is one of the most highly downloaded papers from that journal.
As always, Wikipedia is often a useful source of information, obviously it should not be regarded as gospel. Below are a couple of links demonstrating how much effort is going in to coordinating information about open access information in science. In this connection one must also mention the open access journal called on the Internet called PLoS Medicine (PLoS= Public Library of Science) which was founded by several influential people, including Nobel prize winners.
Two sources of information concerning papers published in the peer-reviewed scientific journals are particularly helpful. The first is the National library of medicine database that is freely available to anyone, even outside of America. This database registers an enormous number of scientific journals in the medical and biological sciences (but not things like food science, geology and astronomy etc). It is possible to go on to that website and search using all of the details that one would normally expect in a database: i.e. the year, volume, page number, keywords, journal names, words in the abstract etc.
It does not take much imagination and enterprise to learn how to find quite a lot of information. However, it is well worth remembering that even sophisticated searches on such databases, performed by experienced librarians, can only be expected to find about half the relevant information that exists. That means that if somebody does a search for serotonin toxicity on such a database, and then compares what they have found with an expert such as myself, they will find the expert often has about twice as much information .
Organising and accessing large numbers of scientific studies is much facilitated by using a dedicated bibliography database. It is hard to manage without one. There are various commercial ones available (I use “Endnote”, but do not recommend it), and a Google search will soon show the variety available. Such tools allow one to interact easily and seamlessly with databases such as the NLM, and to store and organise information. (That means less fiddling around with cutting and pasting information into fields, because it’s all done automatically. A great help with my bad neck).
For those who use Firefox as a browser there is a fantastic add-on called Zotero, which is free and performs as much, and more, compared to the commercially available dedicated bibliographic databases like Endnote. Downloaded references come complete with an abstract of the paper (if one exists) which by itself often contains valuable information which allows assessment of the likely value of the paper concerned. Other information provided includes the authors address and affiliations, allowing direct contact with the author, which means you can request a copy of the paper if needed. However, a note on strategy is relevant here. The journals, mostly owned by big international companies like Wolters Kluwer, Elsevier etc, are beginning to get less than straightforward. Author contact information is not always so easily visible as it used to be. Obviously, there is a major financial advantage to them if you pay them to get a copy of the reprint, rather than write to the author directly, who can usually supply you with a free copy.
These financial considerations are having substantial impact on research, especially independent research done by people like me. Obviously few of us can afford to buy reprints at $30 a copy, especially when 99/100 of them will, on reading, prove to be of little or no use (reprints are mainly geared for purchase by drug companies to fund the journal, encourage them not to be too fussy with peer-review, and be given to doctors to influence prescribing). But, for me, $30 an item would mean paying thousands of dollars to find just one good paper. Even major university libraries are having to cut back on the number of different journals and databases they subscribe to because of the cost.
Nevertheless, going to the journal website and looking carefully usually gives the result (author address), if the address is not registered in the NLM database. If that fails, the NLM database will produce a list of all other papers by the same author at the click of a mouse. It is usually possible to find a different recent paper with an address. Failing that, go to the institution website of one or more of the authors of the paper and it is usually possible to find an e-mail address.
Lastly, one can always have a guess at the e-mail address because many organisations ask people to format their e-mail address in a standard way. So if you know their name & initials you can guess their e-mail address. Try formatting half a dozen different e-mails addresses in slightly different ways to discover which one works (smith.john, smith.j, smithjohn, smithj, etc.
If anybody else has got any other clever techniques they know of in relation to this let me know, I will add them to this commentary if you send them to me.
It is also useful to have some idea of how to assess the likely quality of the information that you are accessing. Things posted on the Internet, like the document you’re reading now, that have not been published in a peer-reviewed journal or other source of quality-controlled information, may have 1001 hidden agendas, biases, inaccuracies, and downright misrepresentations. Few web sites reveal who is providing the finance, the slicker they look the more likely it is that industry money is behind them (I should know, it costs me enough to run my ‘amateur’ website).
Peer-reviewed journals are accorded higher credibility, although that is becoming increasingly frequently an erroneous assumption. See, Medical science publishing: a slow motion train wreck:
It is useful to be aware of prominent doctors involved in sceptical and debunking discussion, because, unfortunately, there is so much to debunk. Ben Goldacre’s book on “Bad Science” is good, even for someone as experienced and cynical as myself. Bad science is like watching a magician. You suspect that your being tricked, but you cannot always see how. So being reminded of the sleights of hand involved is a healthy recreation. See:
and Ben’s homeopathy comments
The American Skeptical Inquirer magazine is good and their website is a portal to quality sceptical views- http://www.csicop.org/si/
See especially http://www.csicop.org/resources#health_and_psychology
Lastly, one or two key references about debunked papers [25, 26, 28, 36-39].
The term ‘peer-review’ refers to the filtering processes that scientific work usually has to go through before it is accepted for publication in a reputable journal. This does not generally apply to books, and often not to papers published in the supplements of journals; why? because, guess what? those supplements are often directly subsidised by drug companies.
When a scientific article is submitted to the editor of a journal for consideration of publication the editor sends it to 2 or three, sometimes even more, experts in the area of study concerned. They comment on it, and recommend to the editor whether or not it should be published. Almost always, if it is recommended for consideration of publication, this will be only after amendments and revisions in response to the comments that the referees will have made. I act as a referee for journals and have a modest amount of experience with this process. This process is far from perfect, but is important as a quality control mechanism for what is published. Nevertheless, it is extremely important for readers to appreciate that just because something is published does not mean it is good, true, or reliable. I will not enter into a diatribe about the imperfections of the peer review system. For those interested see the “Sense about Science” web site, particularly their comment on the recent UK House of Commons Science and Technology Committee report:
and also my commentary
for a detailed comment on peer review etc.
Perhaps the above will give some insight into the difficulties and weaknesses of the peer review system. Nevertheless, it seems to be the best we have at the moment, although it definitely can be improved on, as I suggest in the commentary above, and further elaboration concerning the biases in scientific publishing can be found in my essay on ‘Why antidepressants are ineffective and how drug companies have deceived us’.
Meanwhile it is vitally important to understand that even articles published in the most prestigious peer-reviewed journals cannot, and should not, be accepted without criticism and reservation. Then they must be replicated by other independent research groups.
The fact that replication is so rarely achieved in medical trials severely reduces the confidence is appropriate to invest in most published research, over-and-above the observations made by Ionnidis .
Various measures of the influence of journals and papers exist; journal impact factors, Eigen factor, etc., but what value can be put on them is debatable. For what it is worth, review articles from more prestigious journals may have undergone more rigorous refereeing by better referees and therefore be better than reviews published in lesser journals.
Let us remember that when the editor of the BMJ (Richard Smith) stepped down a few years ago he stated that it had taken them 25 years to appreciate how comprehensively they were being deceived by the drug companies [40, 41]. Richard Smith also suggested scrapping peer review and being wary of ‘top journals’.
World Science: Top 20 Journals
Although the pursuit of scientific truth may be a noble endeavour, and a great proportion of scientists are genuine seekers of knowledge and truth, who strive to be objective, they are still subject to influence by the social and economic influences and forces in society, and sometimes, unfortunately and unscientifically, by their own personal prejudices, beliefs and even mental abnormalities: see commentary on ADs http://www.psychotropical.com/ad_rev.shtml
When considering all that has gone wrong with medical science, one is repeatedly confronted with the excessive and unbalancing influence exerted by the financial muscle of industry lobbying. This factor lies at the heart of many of the problems that are central to bias, misinformation, and distorted research in science. The continuing widespread denial of the long-established evidence strongly supporting anthropogenic climate warming is a currently prominent case in point.
Just as the cartel of cigarette manufacturers, led by Philip Morris, continue to conduct their decades-long billion dollar denial, deceit, disinformation campaign attempting to refute the link between smoking and cancer (and other illnesses), so the pharmaceutical industry have withheld data and twisted and fudged science on a massive scale , probably sufficient to put much recent medical knowledge about drugs in considerable doubt [25, 26].
It is of immense importance for us all to understand the destructive effect of politically, financially, and ideologically fudged science: it is illuminating to be aware of the big picture illustrated by following points.
Ever since the Second World War there has been a vociferous and powerful group who have obscured and distorted the understanding of many basic scientific issues affecting society. The movement denying the role cigarettes play in causing cancer is just the best-known major example, constituting but the tip of the iceberg. There are numerous other equally biased, deceitful, ill-informed and vociferous groups (with many common proponents), funded generously by international industrial and commercial interests, who have consciously and deliberately spread mis-information, errors, deceits and obfuscation to purposefully create unfounded and unjustified doubt in the public mind about an extensive range of topics. This extensive range includes: DDT, asbestos, di-acetyl (the buttery flavor in popcorn), chromium, lead, cadmium, beryllium, mercury, PVC, acid rain, the ozone hole, global warming, the strategic defense initiative, and more (for a fuller coverage see ). See also
The scientists prominently involved from the outset included Robert Jastrow, Frederick Seitz, and S. Fred Singer [42, 43]. The vilification of scientists who have explained, endorsed, and summarized evidence not to their political and bureaucratic masters’ liking has constituted a grave misdemeanor, notably in the Bush administration. Make no mistake, such conduct puts those persons on the same moral and intellectual level as the medieval heretic and witch-hunters of the Spanish inquisition. They are a cancer in the body of any educated, rational, and civilized democracy.
All this should be irrelevant in a commentary such as this: the fact that it is critically relevant is central to understanding the current situation and dilemma in science. It is of grave concern to us all. It is certain that your health, and that of those close to you, has been seriously adversely affected, and will continue to be seriously adversely affected, directly because of these deceitful practices. It matters vitally, and to everyone; as John Donne in the put it in the 17thc:
“No man is an island entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were. Any man’s death diminishes me, because I am involved in mankind. And therefore, never send to know for whom the bell tolls: it tolls for thee.”
Outbreaks of plague were frequent in Donne’s times, so he may have been thinking in that context of our connectedness to, and dependence on, each other. The plague bell rang to give notice of the arrival of the plague cart to carry away the dead. So perhaps he was counselling not to send out your servant to find who was, or was not, dead. After all, we are all in the same boat.
On a lighter note. A few one-liners re President Bush (because his administration did so much harm to science); my favorites, from the multitude of choices, are almost too black to be funny:
Bush and the Republican party: Our bridge to the 16th century
Bush; if you want a nation ruled by religion, move to Iran
Let’s fix democracy in this country first
End of an error.
It is interesting, alarming some might say, that politicians are the only professional group in Western countries where there is no requirement to have any demonstrated competences or qualifications.
No requirement to have:
any minimum educational standard
any practical experience, of anything
any understanding of logic, science, risk, decision making etc.
any academic qualifications, not even basic schooling to age 16
any medical or mental health checks
alcohol or drug screening
minimum IQ or tested capability or any sort
any personality screening, e.g. for psychopathic personalities
any tests of mental competence while in office
formal written ethical guidelines
other suggestions? Honesty, probity …
Note that all the above was written before Trump was even thought of.
My reason for using the heading above ‘the pernicious effect of free-market capitalism’ is clear when one appreciates the history that links these seemingly disconnected subjects and misinformation campaigns. In brief, the connection relates to a faith-based ideology that preaches unfettered free-market capitalism as the only preventative to the dreaded slide into communism (the great American paranoia, remember McCarthy?). It also conveniently justifies and rationalises greed, self-interest, and disregard for the welfare of others. Many capitalists in the Western world, particularly the United States of America, believe in the necessity of preventing governments from engaging in any regulation of the free-market economy (apparently by any and all means at their disposal, including deceit etc.). Some believe* this with a near delusional intensity.
Many in the post-war, cold war era adopted the view that any move towards regulation by government was the first step on the road to communism. It is striking that many of the most influential players in the early campaigns about smoking were scientists involved in the war effort, especially developing the nuclear bomb (none of them were [medical] doctors). Perhaps an emphasis on how dreadful communism was helped to justify their lives and expiate their guilt about the bomb that they had created by making it the necessary antidote to that communist evil. One can thus understand their simplistic dogmatic stance about the requirement to avoid regulation and thus even a single step down that dreaded road to communism.
So, these campaigns are linked together by this obsession of preventing any government regulation of free enterprise to avoid the dreaded descent into communism. As Professor Oreskes put it ‘today tobacco smoke, tomorrow the Bill of Rights’ .
The above understanding illuminates many present examples of distorted science and bad medicine and connects them to history. Anyone who doubts the reality and validity of these comments would probably alter their opinion if they read the following references which document in detail the people, companies, and methods that have been employed to mislead and deceive people. These two books: Michaels: Doubt is their product: how industry’s assault on science threatens your health, and Conway and Oreskes: Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming [42-44] are strongly recommended for those would like a more comprehensive, accurate and objective view of history.
This issue really matters. Right now, someone you know or love is being disadvantaged, ripped off, or even poisoned, as a result of these practices.
It really is no wonder that despite America being almost the richest country in the world it has some of the poorest health related outcomes.
* The word “believe” inevitably comes up from time to time. It is a word that has no place in science. A Scientist’s current view about a topic should be the best interim explanation of the evidence currently available and will be appropriately modified according to new or altered evidence and observations. All available observations need to be considered dispassionately. When people start talking about belief it indicates they have an emotional investment in adopting a preconceived point of view. That inevitably means they will selectively attend to evidence that supports their existing thinking (termed confirmation bias), rather than considering all the available evidence on its merits. That is an important difference between good and bad [scientific] thinking.
If you think we are over this medieval anti-intellectualism, just consider the present, Liam Fox and the Texan, Rick Perry, see this piece. Perry ‘has elevated denial of science, from climate change to evolution, to an art form. He opposes any regulation of industry, and has repeatedly challenged the authority of the Environmental Protection Agency.’
and for a summary of relevant history and of the qualifications of Republicans see New Scientist:
“Science in America: Decline and fall”
1. Lewontin, R.C., Biology as Ideology. The Doctrine of DNA. 1991: HarperCollins.
2. Kieling, C., et al., A current update on ADHD pharmacogenomics. Pharmacogenomics, 2010. 11(3): p. 407-19.
3. Kirchheiner, J., A. Seeringer, and R. Viviani, Pharmacogenetics in psychiatry–a useful clinical tool or wishful thinking for the future? Curr Pharm Des, 2010. 16(2): p. 136-44.
4. Lohoff, F.W. and T.N. Ferraro, Pharmacogenetic considerations in the treatment of psychiatric disorders. Expert Opin Pharmacother, 2010. 11(3): p. 423-39.
5. Moller, H.J. and D. Rujescu, Pharmacogenetics–genomics and personalized psychiatry. Eur Psychiatry, 2010. 25(5): p. 291-3.
6. Mrazek, D.A., Psychiatric pharmacogenomic testing in clinical practice. Dialogues Clin Neurosci, 2010. 12(1): p. 69-76.
7. Need, A.C. and D.B. Goldstein, Whole genome association studies in complex diseases: where do we stand? Dialogues Clin Neurosci, 2010. 12(1): p. 37-46.
8. Plesnicar, B.K., Personalized antipsychotic treatment: the adverse effects perspectives. Psychiatr Danub, 2010. 22(2): p. 329-34.
9. Zandi, P.P. and J.T. Judy, The promise and reality of pharmacogenetics in psychiatry. Psychiatr Clin North Am, 2010. 33(1): p. 181-224.
10. Fuhr, U., et al., Assessment of Pharmacokinetic Drug–Drug Interactions in Humans: In Vivo Probe Substrates for Drug Metabolism and Drug Transport Revisited. Annual review of pharmacology and toxicology, 2019. 59: p. 507-536.
11. Lauschke, V.M. and M. Ingelman-Sundberg, Prediction of drug response and adverse drug reactions: from twin studies to next generation sequencing. European Journal of Pharmaceutical Sciences, 2019. 130: p. 65-77.
12. Bousman, C., A. Al Maruf, and D.J. Müller, Towards the integration of pharmacogenetics in psychiatry: a minimum, evidence-based genetic testing panel. Current opinion in psychiatry, 2019. 32(1): p. 7-15.
13. Walden, L.M., et al., Genetic testing for CYP2D6 and CYP2C19 suggests improved outcome for antidepressant and antipsychotic medication. Psychiatry research, 2019. 279: p. 111-115.
14. Dalton, R., et al., Interrogation of CYP 2D6 Structural Variant Alleles Improves the Correlation Between CYP 2D6 Genotype and CYP 2D6‐Mediated Metabolic Activity. Clinical and translational science, 2020. 13(1): p. 147-156.
15. Vassy, J.L., et al., Pharmacogenetic testing in the Veterans Health Administration (VHA): policy recommendations from the VHA Clinical Pharmacogenetics Subcommittee. Genetics in Medicine, 2019. 21(2): p. 382-390.
16. Na Takuathung, M., et al., Impact of CYP1A2 genetic polymorphisms on pharmacokinetics of antipsychotic drugs: a systematic review and meta‐analysis. Acta Psychiatrica Scandinavica, 2019. 139(1): p. 15-25.
17. Ferner, R. and J. Aronson, Susceptibility to adverse drug reactions. British journal of clinical pharmacology, 2019. 85(10): p. 2205-2212.
18. van Hasselt, J.C. and R. Iyengar, Systems pharmacology: defining the interactions of drug combinations. Annual review of pharmacology and toxicology, 2019. 59: p. 21-40.
19. Heneghan, C., et al., Evidence based medicine manifesto for better healthcare: A response to systematic bias, wastage, error and fraud in research underpinning patient care. Evid Based Med, 2017.
20. Allison, D.B., et al., Reproducibility: A tragedy of errors. Nature, 2016. 530(7588): p. 27-9.
21. Ioannidis, J.P.A., The Reproducibility Wars: Successful, Unsuccessful, Uninterpretable, Exact, Conceptual, Triangulated, Contested Replication. Clin Chem, 2017. 63(5): p. 943-945.
22. Lexchin, J., Those Who Have the Gold Make the Evidence: How the Pharmaceutical Industry Biases the Outcomes of Clinical Trials of Medications. Sci Eng Ethics, 2011.
23. Lexchin, J., et al., Pharmaceutical industry sponsorship and research outcome and quality: systematic review. British Medical Journal, 2003. 326(7400): p. 1167-70.
24. Sismondo, S., Pharmaceutical company funding and its consequences: a qualitative systematic review. Contemp Clin Trials, 2008. 29(2): p. 109-13.
25. Ioannidis, J.P., An epidemic of false claims. Competition and conflicts of interest distort too many medical findings. Sci Am, 2011. 304(6): p. 16.
26. Ioannidis, J.P., Why most published research findings are false. Public Library of Science: Medicine, 2005. 2(8): p. e124.
27. Lathyris, D.N., et al., Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest, 2010. 40(2): p. 172-82.
28. Huston, P. and D. Moher, Redundancy, disaggregation, and the integrity of medical research. Lancet, 1996. 347(9007): p. 1024-6.
29. Roseman, M., et al., Reporting of conflicts of interest in meta-analyses of trials of pharmacological treatments. JAMA, 2011. 305(10): p. 1008-17.
30. Becker, A., et al., The association between a journal’s source of revenue and the drug recommendations made in the articles it publishes. CMAJ, 2011. 183(5): p. 544-8.
31. Turner, E.H., et al., Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med, 2008. 358(3): p. 252-60.
32. Light, D.W., Basic research funds to discover important new drugs: Who contributes how much?, in Monitoring financial flows for health research:Behind the global numbers, M.A. Burke and A. de Francisco, Editors. 2006, Global Fund for Health Research: Geneva. p. 29-43.
33. Garattini, S. and I. Chalmers, Patients and the public deserve big changes in evaluation of drugs. BMJ, 2009. 338: p. b1025.
34. Bekelman, J.E., Y. Li, and C.P. Gross, Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA, 2003. 289(4): p. 454-65.
35. McManus, R.J., et al., Review of the usefulness of contacting other experts when conducting a literature search for systematic reviews. BMJ, 1998. 317(7172): p. 1562-3.
36. Gotzsche, P.C., et al., Ghost Authorship in Industry-Initiated Randomised Trials. PLoS Med, 2007. 4(1): p. e19.
37. Campbell, M.K., D.R. Elbourne, and D.G. Altman, CONSORT statement: extension to cluster randomised trials. British Medical Journal, 2004. 328(7441): p. 702-8.
38. Higgins, J.P., et al., Measuring inconsistency in meta-analyses. British Medical Journal, 2003. 327(7414): p. 557-60.
39. Day, S.J. and D.G. Altman, Statistics notes: blinding in clinical trials and other studies. British Medical Journal, 2000. 321(7259): p. 504.
40. Smith, R.L., Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. Public Library of Science: Medicine, 2005. 2: p. e138.
41. Spielmans, G.I. and P.I. Paarry, From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents. Journal of Bioethical Inquiry, 2010. 7: p. 13-29.
42. Michaels, D., Doubt is their product: how industry’s assault on science threatens your health. 2010.
43. Conway, E.M. and N. Oreskes, Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming. 2011: Bloomsbury Publishing.
44. Oreskes, N., Beyond the ivory tower. The scientific consensus on climate change. Science, 2004. 306(5702): p. 1686.