Andrew Wakefield has received a great deal of negative publicity over the past few weeks, ever since journalist Brian Deer, writing in the British Medical Journal, presented evidence that Wakefield faked the data in his study linking the MMR vaccine to autism. Deer also made the case that Wakefield’s motive was financial gain: Wakefield was employed by a lawyer who planned a highly lucrative lawsuit against vaccine manufacturers and investors were promised millions.
Wakefield has publically responded to the charges. In a story from Bloomberg he asserts that his study was “not a hoax.” He also says: “I have lost my job, my career and my country.”
Given the stressful nature of Wakefield’s situation – some accuse him of a moral crime, others feel he should be prosecuted – it’s both eerie and fascinating to watch him defend himself. He appeared on “Good Morning America,” where he was interviewed by George Stephanopolous. In that interview, Wakefield claims his accuser committing a fraud by selectively omitting data.
Did we stop respecting scientists and doctors 60 years ago?
The “Good Morning America” interview was preceded by a video back-story on autism and the MMR vaccine. It describes how the Wakefield case has undermined the medical community and how parents are now suspicious of physicians’ advice.
That may be a fair enough statement. But the report goes on to say that the Wakefield case has undermined public confidence in both science and medical research and that “the whole field of science has taken a hit.” Seth Mnookin, author of “The panic virus,” says: “Sixty years ago, doctors and scientists were among the most respected members of society. That is not at all the case today.”
A slightly more reasonable statement is made in the “print” story in which the video appears. It’s from David Amaral of the University of California, Davis: “What is most destructive in an episode such as this is the undermining of the public’s confidence in the integrity of science. … Without replication, fraud and poorly conducted research will not stand the test of time.”
Here’s the back-story video.
There’s an element of truth in questioning public confidence – especially with regard to patients having doubts about the reliability of medical advice – but the report overstates the situation. For one thing, medicine is not a science like physics, chemistry, and astronomy, much as it would like to be. There is so much unknown about the human body. We don’t expect medicine to arrive at definitive knowledge that remains unquestioned for multiple decades.
For another, most people do not follow developments in the non-medical sciences. Medicine gets a great deal of publicity, partly because medical research can have an immediate impact on human lives. This is much less true of the latest discoveries in the physical sciences. Despite exciting developments in physics and astronomy, including competing theories, the public has not lost confidence in physics and astronomy. So I question whether “the whole field of science has taken a hit.”
Finally, the behavior of someone like Wakefield (assuming Deer’s evidence is reliable), may cause the public to doubt the integrity of scientists, but not the validity of science itself. The two are not identical.
I’m also a little puzzled by Mnookin’s singling out “sixty years ago” – 1950 – as the time when doctors and scientists were more respected than they are today. That’s true, but it doesn’t say much. The decline in public regard for medical practitioners didn’t start until decades later. Socially, politically, and culturally, science was highly regarded in the 1960s. Scientific research was credited with social and economic progress. The 1960s saw criticisms of science as a “tool” of political, military, and corporate interests, but this was a political critique, not a particularly widespread public assessment.
The integrity of scientists and the validity of science
There has been a great deal of negative publicity over the past few decades that raises questions about the integrity of scientists. This has primarily been connected to the area of medical research and much of it is associated with the pharmaceutical industry. Doctors sign their names to papers that describe clinical trials of a drug. The papers turn out to be ghostwritten and paid for by the drug manufacturer. Doctors – key opinion leaders — are paid handsomely by pharmaceutical companies to promote drugs to other doctors. The pharmaceutical industry buries any study it doesn’t like, creating the impression that the majority of studies are favorable to what the industry wants us to believe. Journals are biased towards the publication of studies with positive results.
All of these practices greatly skew doctors’ opinions of which drugs are effective and safe. Patients die needlessly as a result, and only then does the truth come out in whistle blower lawsuits. Indeed, it’s a sad state of affairs that reflects on the ethics and integrity of medical science.
Recently, however, there have been some interesting developments that raise questions not about the integrity of science and scientists, but about the underlying validity of science itself.
There is, for example, Jonah Lehrer’s recent article in the New Yorker, “The Truth Wears Off,” which raised the question of whether scientific results can be replicated. Another incident creating a buzz is the publication — in a reputable psychology journal — of an article proving the existence of extrasensory perception. The ability to prove that ESP exists had led scientists to question the statistical methods used to reach conclusions. These methods are common in almost all analyses of clinical trial results.
David H. Freedman’s book, Wrong: Why experts* keep failing us–and how to know when not to trust them, is a thoughtful discussion of why scientists and other experts are as likely to be wrong as right. His article in The Atlantic, “Lies, Damned Lies, and Medical Science,” discusses the work of Dr. John Ioannidis, who has documented how common it is for published medical research – findings on which medical practice is based — to be refuted by later studies.
A history of questioning science
In the late 1970s, Ivan Illich published Limits to Medicine: Medical Nemesis, the Expropriation of Health. He argued that medicine was turning people into lifelong patients and doing more harm than good. His critique – while valuable – was limited in that he singled out the medical profession for blame. We now realize that the medicalization of life – turning birth, death, menopause, aging, short stature, and sadness into diseases with medical solutions — stems from the political and economic environment in which doctors practice. Illich’s insights are more or less ignored and discredited these days.
In the 1990s, social scientists and postmodernists attacked science from a social constructionist point of view. They made the case that scientists were unaware of their own biases, which arise unavoidably from the social and economic systems in which they observe and reason.
As with Illich, the critics had some valid insights, which scientists were theoretically intelligent enough to appreciate. But scientists were extremely defensive about the criticism. A physicist, Alan Sokal, wrote a paper on the socially constructed character of quantum gravity theory and got it published in a social constructionist journal. The paper was a hoax, which Sokal gleefully exposed, and scientists then declared themselves victorious over their enemy.
In the 21st century, the debate over the scientific validity of climate change findings has certainly been very challenging for scientists. Opponents of climate change have used truthiness – the appeal to emotion at the expense of facts — and denialism to question both the integrity of scientists (Climategate emails) and the validity of science.
Does science correspond to reality or is it a transient opinion?
In a series of lectures called Science Wars, the brilliant historian of science Steven Goldman chronicles how the validity of science has been questioned from the time of Greek antiquity to the present day. The purpose of his lectures is to understand the nature of scientific knowledge.
Are scientific theories true because they correspond to reality? How can we know that they do, given that we have no access to reality except through experience, which scientists themselves tell us is profoundly different from the way things “really” are? Are theories true because they account for experience and make correct predictions? This sounds plausible, but theories that we now consider wrong once were considered true because they accounted for our experience and made successful predictions then! Should we assume that as new experiences accumulate, current theories will be replaced, as all previous theories have been? But in that case, theories are not really knowledge or truth, in the strict sense of those words, but a special case of experience-validated educated opinion.
This is similar to the conclusion Jonah Lehrer reaches at the end of his New Yorker article: “Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe.”
The new issues raised by Lehrer, Freedman, and the ESP study are yet another chapter in the contentious relationship between science and its critics. They have the potential to touch on matters far more significant than those raised by a rogue physician such as Andrew Wakefield. It is not the integrity of scientists they are questioning, but whether fundamental assumptions at the basis of scientific research are valid. This promises to take the issue of public trust in science and medicine to a whole new level.
Wakefield study of vaccine/autism link is a fraud
“Tyranny of health” on KevinMD
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Merchants of Doubt
Scientists confront political attacks on climate change
Health news and competitive journalism
Image: Mail Online
Lara Salahi, British Researcher Wakefield Defends Link Between Vaccine and Autism, ABC News, January 17, 2011
Brian Deer, How the case against the MMR vaccine was fixed, The British Medical Journal, January 5, 2011
Allison Connolly, Autism Study Tying Disorder to Vaccine Was `Not a Hoax,’ Researcher Says, Bloomberg, January 13, 2011
Jonah Lehrer, The Truth Wears Off, The New Yorker, December 13, 2010
Benedict Carey, You Might Already Know This …, The New York Times, January 10, 2011
David H. Freedman, Wrong: Why experts* keep failing us–and how to know when not to trust them *Scientists, finance wizards, doctors, relationship gurus, celebrity CEOs, … consultants, health officials and more
David H. Freedman, Lies, Damned Lies, and Medical Science, The Atlantic, November 2010
Steven L. Goldman, Science Wars – What Scientists Know and How They Know It
Ray Moynihan, Key opinion leaders: independent experts or drug representatives in disguise?, The British Medical Journal, June 19, 2008