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Tuesday, September 7, 2010

Science, Skepticism, and Advocacy

I spent part of my Labor Day weekend transporting household goods to and working around our mountain home a few hours from where we live. One of my colleagues, who I have not had much of a chance to hang with, accompanied me and I was pleasantly surprised that he is quite proficient with the chain saw. He calls himself a "chain saw stud" which was just fine since he was able to clear trees which would have taken days to cut with my wimpy handsaw.

One of the treats of the trip was the opportunity to catch up on his science and find potential common areas of interest and scientific collaboration. We also talks about the respective challenges that we face as individual faculty, the challenges of our institution, and the challenges being faced by the research and clinical establishments as a whole. One thing that he voiced great concern about was what he saw as an unhealthy rise in distrust of experts in general. I agree that both the basic scientific community and the medical communities have seen an increase in general skepticism from the public. However, I am not so sure that the present state represents an aberration an I suspect that the period of remarkable trust which was ushered in after WWII is the real aberration.

I see this return to a more "natural" state as being a consequence of human nature. Many of us are simply suspect of authority, and this distrust may serve many useful functions. This is particularly true within the scientific community. Scientists are skeptics since the scientific method is based upon skepticism. The practice of science involves formulating and testing hypotheses, assertions that are potentially falsifiable using reproducible data derived from experimentation. The trust we gained was based upon the public belief that scientists had developed unique tools to ascertain and were beholden to the truth. The assumption was that if we could prove our beliefs wrong we would shed our beliefs. 

Well, not so fast. If science and scientists could maintain a firewall which allowed them to pose their hypotheses and do their experiments cloistered from politics, policy, and money, there would be no problem. Similarly, if clinicians could take care of patients and make their decisions without regard to their own interest and money, health care finance and politics would be much less complex. That is simply fantasy. With information comes authority and with authority comes power and something to lose. Our work, whether clinical or laboratory, tends to be resource intensive and can only be maintained with substantial flows of money. Who can or will guarantee that the resource stream will continue?

Enter the mixture of science, politics, and advocacy. The question is does science and advocacy mix well? Can a scientist be both a scientist and an advocate at the same time? I believe here are the origins of the mistrust which has reappeared. When the public sees a scientist testifying in front of Congress, they see an advocate, much like advocates from the auto industry, Greenpeace, or whatever. They may be providing "scientific" testimony, but are more likely venturing outside of science and skepticism which science requires. For them to advocate, it requires more in the realm of beliefs than what is testable and falsifiable. Scientists and other experts in this context may deserve as much trust and respect as any other person advocating for their strongly held beliefs. 



2 comments:

Michael Kirsch, M.D. said...

Slight disagreement here. I think it's proper for scientists, and even physicians, to testify and advocate. Personal integrity should be the firewall that separates science from opinions and personal agendas. Interesting post.

The Medical Contrarian said...

Thank you for your comments, insightful as always. It would be great if personal integrity could function as such a firewall. However, from a practical viewpoint, how does that work? When a scientist submits a paper for publication, peer review often is merciless about the entry of speculation into the manuscript(and it should be!), However, the scientist as the advocate is encouraged to speculate and there is no clear line made to where the science stops and the speculation begins.

The more the conflate what is science and what are our opinions based upon speculation, the more we will lose the public trust.