Why skepticism about science and medicine?

(cross-posted from scimedskeptic.wordpress.com)

My skepticism is not about science and medicine as sources or repositories of objective knowledge and understanding. Skepticism is demanded by the fact that what society learns about science and medicine is mediated by human beings. That brings in a host of reasons for skepticism: human fallibility, individual and institutional self-interest, conflicts of interest, sources of bias and prejudice.

I have never come across a better discussion of the realities about science and its role in society than Richard Lewontin’s words in his book, Biology as Ideology (Anansi Press 1991, HarperPerennial 1992; based on 1990 Massey Lectures, Canadian Broadcasting Corporation):

“Science is a social institution about which there is a great deal of misunderstanding, even among those who are part of it. . . [It is] completely integrated into and influenced by the structure of all our other social institutions. The problems that science deals with, the ideas that it uses in investigating those problems, even the so-called scientific results that come out of scientific investigation, are all deeply influenced by predispositions that derive from the society in which we live. Scientists do not begin life as scientists, after all, but as social beings immersed in a family, a state, a productive structure, and they view nature through a lens that has been molded by their social experience.
. . . science is molded by society because it is a human productive activity that takes time and money, and so is guided by and directed by those forces in the world that have control over money and time. Science uses commodities and is part of the process of commodity production. Science uses money. People earn their living by science, and as a consequence the dominant social and economic forces in society determine to a large extent what science does and how it. does it. More than that, those forces have the power to appropriate from science ideas that are particularly suited to the maintenance and continued prosperity of the social structures of which they are a part. So other social institutions have an input into science both in what is done and how it is thought about, and they take from science concepts and ideas that then support their institutions and make them seem legitimate and natural. . . .
Science serves two functions. First, it provides us with new ways of manipulating the material world . . . . [Second] is the function of explanation” (pp. 3-4). And (p. 5) explaining how the world works also serves as legitimation.

Needed skepticism takes into account that every statement disseminated about science or medicine serves in some way the purpose(s), the agenda(s), of the source or sources of that statement.

So the first thing to ask about any assertion about science or medicine is, why is this statement being made by this particular source?

Statements by pharmaceutical companies, most particularly their advertisements, should never be believed, because, as innumerable observers and investigators have documented, the profit motive has outweighed any concern for the harm that unsafe medications cause even as there is no evidence for definite potential benefit. The best way to decide on whether or not to prescribe or use a drug is by comparing NNT and NNH, the odds on getting benefit compared to the odds of being harmed; but NNT and NNH are never reported by drug companies. For example, there is no evidence whatsoever that HPV vaccination decreases the risk of any cancer; all that has been observed is that the vaccines may decrease genital warts. On the other hand, many individuals have suffered grievous harm from “side” effects of these vaccines (see Holland 2018 in the bibliography cited just below, and the documentary, Sacrificial Virgins. TV ads by Merck, for example in August 2020 on MSNBC, cite the Centers for Disease Control & Prevention as recommending the vaccine not only for girls but also for boys.

For fully documented discussions of the pervasive misdeeds of drug companies, consult the books listed in my periodically updated bibliography, What’s Wrong with Present-Day Medicine.
I recommend particularly Angell 2004, Goldacre 2013, Gøtzsche 2013, Healy 2012, Moynihan, & Cassels 2005. Greene 2007 is a very important but little-cited book describing how numbers and surrogate markers have come to dominate medical practice, to the great harm of patients.

Official reports may be less obviously deceitful than drug company advertisements, but they are no more trustworthy, as argued in detail and with examples in “Official reports are not scientific publications”, chapter 3 in my Dogmatism in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth (McFarland 2012):
“reports from official institutions and organizations . . . are productions by bureaucracies . . . . The actual authors of these reports are technical writers whose duties are just like those of press secretaries, advertising writers, and other public-relations personnel: to put on the actual evidence and conclusions the best possible spin to reinforce the bureaucracy’s viewpoint and emphasize the importance of the bureaucracy’s activities.
Most important: The Executive Summaries, Forewords, Prefaces, and the like may tell a very different story than does the actual evidence in the bulk of the reports. It seems that few if any pundits actually read the whole of such documents. The long public record offers sad evidence that most journalists certainly do not look beyond these summaries into the meat of the reports, given that the media disseminate uncritically so many of the self-serving alarums in those Executive Summaries” (p. 213).

So too with press releases from academic institutions.

As for statements direct from academic and professional experts, recall that, as Lewontin pointed out, “people earn their living by science”. Whenever someone regarded as an expert or authority makes public statements, an important purpose is to enhance the status, prestige, career, profitability, of who is making the statement. This is not to suggest that such statements are made with deliberate dishonesty; but the need to preserve status, as well as the usual illusion that what one believes is actually true, ensures that such statements will be dogmatically one-sided assertions, not judicious assessments of the objective state of knowledge.

Retired academic experts like myself no longer suffer conflicts of interest at a personal or institutional-loyalty level. When we venture critiques of drug companies, official institutions, colleges and universities, and even individual “experts” or former colleagues, we will be usually saying what we genuinely believe to be unvarnished truth. Nevertheless, despite the lack of major obvious conflicts of interest, one should have more grounds than that for believing what we have to say. We may still have an unacknowledged agenda, for instance a desire still to do something useful even as our careers are formally over. Beyond that, of course, like any other human beings, we may simply be wrong, no matter that we ourselves are quite sure that we are right. Freedom from frank, obvious conflicts of interest does not bring with it some superhuman capacity for objectivity let alone omniscience.

In short:
Believe any assertion about science or medicine, from any source, at your peril.
If the matter is of any importance to you, you had best do some investigating of evidence and facts, and comparison of diverse interpretations.

Treatment Guidelines are dangerous

Already some of my earliest posts exposed the lie implicit in calling antiretroviral drugs “life-saving”:

— “the NIH Fact Sheet reports deaths ‘from liver failure, kidney disease, and cardiovascular complications’ in the first decade of HAART (‘cocktail’) therapy, and the largest study to date (of 22,000 patients) found that the drugs do not decrease mortality — in other words, they don’t save lives” (Best treatment for HIV: This year’s advice, last year’s, or next year’s?).

— The official Treatment Guidelines of the National Institutes of Health change incessantly, are based more on opinion than on scientific evidence, rely on surrogate markers rather than patient health, and are so complex and change so often that physicians must suffer constant dilemmas over how to advise their patients (Antiretroviral drugs: history and rhetoric).

I pointed out that the Guidelines are drawn up by panels of experts of whom almost all have direct conflicts of interest with manufacturers of antiretroviral drugs (Conflicts of interest).
The widespread harm done by the toxicity of antiretroviral treatment practiced according to these Guidelines featured in all too many subsequent posts:

What HIV drugs do;    First: do no harm!;    To avoid HIV later, damage your kidneys and liver now;     Death, antiretroviral drugs, and cognitive dissonance;     HIV/AIDS scam: Have antiretroviral drugs saved 3 million life-years?;     Antiretroviral treatment benefits? from 3 million to 1.2 million to …!?!;    Nevirapine, TB, and HIV/AIDS;    Nevirapine — P.S.;    HAART saves lives — but doesn’t prolong them!?;    “AIDS” deaths: owing to antiretroviral drugs or to lack of antiretroviral treatment?;    HAART and HIV/AIDS: Dilemmas, Paradoxes, and Errors;    Poison in South Africa;     State of HIV/AIDS Denial: Carcinogenic HAART;    Living with HIV; Dying from What?;     Prophylaxis via organ failure and bankruptcy;    Tenofovir and the ethics of clinical trials;    HAART? You’ve got to be crazy . . . ;    How antiretroviral drugs are approved;     Drug peddlers’ ads ignore FDA;     The Lazarus effect in HIV/AIDS;    HAART kills hearts;    HAART makes things worse: Elsevier journal publishes HIV/AIDS heresies;    Kidney-disease denialism (a special case of HAART denialism);    HAART denialism, contd.;    HAART causes strokes;    Hidden in plain sight: The damage done by antiretroviral drugs;    HAART is toxic: Mainstream concedes it, in backhanded ways;    Spinning Truvada;    Antiretroviral drugs lead to normal life?;    Killing a baby;    Breaking News: Baby Rico rushed to ER, Taken Off Medication

 

I’ve become increasingly aware that what has gone wrong in the science and practice of HIV/AIDS reflects what has gone wrong in the wider spheres of medical science and practice and indeed of science in general. The present post was stimulated by Jeanne Lenzer’s article in the British Medical Journal, “Why we can’t trust clinical guidelines”.

As I point out about that important piece on my other blog (Why NOT to “Ask your doctor”), the damage done by drug-based medical practice has been described in devastating fashion by Ben Goldacre in Bad Pharma, and corruption of science by outside interests is delineated in my Dogmatism  in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth.

Peer review is no better than in-house reports — OFFICIAL!

When you’re in a hole, and you head the International Panel on Climate Change, dig yourself in deeper, and incidentally give continuing comfort to your critics, as well as to critics of other  official international boondoggles (“IPCC’s Parchauri [sic] says climate body must ‘listen and learn’”, by Richard Black, 14 May 2010):
“He [Rajendra Pachauri, head of IPCC] . . . defended the principle of using non-peer-reviewed materials, such as the WWF report wherein the Himalayan error originated, which said the mountain range’s glaciers could disappear by 2035. ‘I’d like to highlight what non-peer-reviewed literature constitutes: reports from the International Energy Agency, the OECD, the UN Food and Agriculture Organization, the World Bank, the Asian Development Bank and organisations of this nature. ‘There are some highly prestigious NGOs that are doing detailed academic work, and you cannot ignore this.’ But, he observed, people working on assessment had to follow scrupulously the procedures on when and how to use such material and occasionally, as with the Himalayan episode, human error had crept in. . . .
Although Friday’s contributions at the initial hearing here in Amsterdam all come from IPCC and UN personnel, Dr Robbert Dijkgraaf, co-chair of the InterAcademy Council, said the panel would be looking to draw on different shades of opinion over the next few months. . . .
Roger Piekle Jr, a professor of environmental studies at the University of Colorado who has researched the likely costs of natural disasters, remains dissatisfied with the IPCC’s response, and maintains that the review must listen to critical voices if [it] is to be effective. . . .
’However, there are risks here as well, as a poorly conducted review could irreparably damage the institution.’ He also said the review should look at conflicts of interest within the IPCC.”

Note:
1. Alert observers of scientific activities will relish Dr. Pachauri’s concession that “occasionally” human error creeps into scientific matters. Who would have thought that? It’s almost as though scientists were human — when everyone knows, surely, that they are not fallible like politicians or journalists, say.
2. Supporters of Medical Hypotheses and of its editor, Dr. Bruce Charlton,  will accept graciously this confirmation from on high that peer review is by no means the best avenue to getting the most worthwhile material disseminated.
3. People familiar with “reports from the International Energy Agency, the OECD, the UN Food and Agriculture Organization, the World Bank, the Asian Development Bank and organisations of this nature” will be astonished that anyone would regard these biased, agenda-driven, in-house publications as in any way to be relied upon. After all, the organizations producing these reports share the practice of themselves disclaiming responsibility for the accuracy of what is in their reports, e.g.
“The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use” (World Bank, Intensifying Action Against HIV/AIDS in Africa–Responding to a Development Crisis–AFRICA REGION–THE WORLD BANK, 1999); yet the authors of the report, which was issued by the World Bank, are employees of the World Bank and produced the report as part of their employment there.
More succinctly,
“UNAIDS does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use” (UNAIDS, Report on the global HIV/AIDS epidemic 2008; UNAIDS/08.25E / JC1510E).
4. AIDS Rethinkers will note that IPCC has the same approach to “reviewing” as does Elsevier: namely, make sure that all “reviewers” are people who are already in your camp and of your opinion.
5. Dr. Piekle’s warning that an honest, unbiased review carries risks is unnecessary. IPCC, Elsevier, and other such organizations are perfectly well aware of that. That’s why they avoid unbiased reviewing.
As to conflicts of interest, in their absence the IPCC, Elsevier, and their kin would be out of business.

Institutionalizing conflicts of interest

A fellow scientist of my generation likes to describe us as “dinosaurs”, and periodically accuses me of naivety if I slip into suggesting that facts win out in the end or that scientific ideals and traditional ethics have not been completely abandoned.

I guess it’s true that I’ve written and continue to write as though there are people out there who share my disbelief at, for example, the brushing aside of conflicts of interest as only “apparent” (see “Consequences of misconduct in science”).  And there ARE people who share my attitude, call them naïve and unrealistic if you wish: there’s Sheldon Krimsky, Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? (Rowman & Littlefield, 2003); there’s Andrew Stark, Conflict of Interest in American Public Life (Harvard, 2000); there are Centers for Ethics, and periodicals devoted to ethics in research. Plenty of academics are aware of the sad fact that science and medicine, both research and patient care, have been pervasively infiltrated in a way that might even be called corrupting.

Researchers and administrators of research, however, seem oblivious. Well into the 1970s and even the 1980s, universities were at least trying to apply some brakes. We had to make formal application if we consulted more than half a day per week, and if our remuneration exceeded some modest amount. We were not permitted to run a business that was in any way connected with our academic responsibilities. We took for granted the burden of offering our professional advice as to the publishability of manuscripts or the qualifications of candidates for jobs or promotions. When we traveled to present invited seminars or to advise academic institutions, we didn’t expect honoraria in addition to having our expenses covered — and we felt unusually appreciated when we received honoraria equivalent to a few hours of our annual salary. We regarded it as exceptional perks — comparing ourselves to so many other people- — that our university salaries were paid on a 9-month or 10-month basis, permitting us to teach r do research for an extra 20% or so of annual remuneration. I recall being shocked, in the early 1980s, when professors of English were asking remuneration for reading book manuscripts of candidates for tenure.

What a different world it is, just a couple of decades later. A misguided Director of the National Institutes of Health dropped certain restrictions on outside income, with predictably disgusting consequences (David Willman, Los Angeles Times, 7 December 2003: “Stealth merger: Drug companies and government medical research”, p. A1; “Richard C. Eastman: A federal researcher who defended a client’s lethal drug”, p. A32; “John I. Gallin: A clinic chief’s desire to ‘learn about industry’”, p. A33; “Ronald N. Germain: A federal lab leader who made $1.4 million on the side”, p. A34; “Jeffrey M. Trent: A government accolade from a paid consultant”, p. A35; “Jeffrey Schlom: A cancer expert who aided studies using a drug wanted by a client”, p. A35.)

Just as with political lobbying, we Americans seem able to euphemize, ignore, and even defend practices that in other lands we would be quick to recognize as plain corruption. What set off this tirade was a news item in the Chronicle of Higher Education, 20 June 2008, p. 13: “To lure top scientists, NIH raises pay for some peer reviewers”, by Jeffrey Brainard. Here are a few extracts:

“The National Institutes of Health plans a major increase in the money to provides to long-serving peer reviewers . . . . Some will receive $250,000 for six years . . . . Under the current terms of $200 per day, such scientists would net only about $6000 after six years”.
[Peanuts! Coffee money! But, after all, this is in addition to their salaries wherever they happen to be working, their pay isn’t cut just because they’re away from the office or the lab. And that $200 per day is in addition to expenses, of course, for travel, food, and accommodation; expenses that can be and are often padded a little.]

“But the largesse . . . . would benefit only a few hundred of the several thousand scientists who help evaluate grants of the institutes. . . . Traditionally, many scientists have willingly reviewed applications, though the fees they have been paid fell well short of the value of the time commitment required: at the NIH, 40 to 80 hours of preparation for each day-and-a-half meeting” — Right. I’ve known quite a few people who have served in this way. (Serving as  an academic dean teaches quite a lot about human nature.) Those who spent anything like that amount of preparatory time did it because of their sense of responsibility and don’t need extra money, while those who expect the money and will not otherwise serve will also not spend that amount of time on it.

“’In the end, peer review is only as good as the quality of the people doing it,’ said Elias A. Zerhouni, the NIH’s director”.
Yes, indeed. We need honest, conscientious people who do these things because their profession is a vocation, a calling, not just a way to earn a living, and certainly not a way to acquire wealth.
[Zerhouni continued,] “I think you get what you pay for”.
And there you have it.
— Want medical care? The more you pay, the better care you’ll get. But didn’t we used to think that was a dreadful situation, when behind the Iron Curtain one had to give bribes and tips to get proper care?
— Want education for yourself or your children? The more you can pay, the better education they will get. But isn’t there some sort of consensus still that every American child should get every educational opportunity they can benefit from?
— Want honest evaluation of research? You’d better pay for it, especially to people who don’t need the money because they earn so much already.
It reminds me of the philosopher, I don’t recall whether it was Mort Sahl or Bob Newhart or Tom Lehrer, certainly one of their ilk, about responding to question from students: “And, of course, if you raise my pay, I’ll even give them correct answers”.

But it’s not all gravy, we’re told. “The $250,000 compensation [lovely choice of word] will be awarded as an ‘administrative supplement’ to existing research grants”, so the recipients can use it at will: “They will keep only some of the money, as salary — the underlying grants also typically finance research equipment and laboratory assistants”.

And of course this administrative supplement is in addition to the $200 daily honoraria.

“NIH leaders rejected, though, a controversial proposal by a peer-review task force that would have capped at five the number of research grants that any one scientist could hold, in order to spread dollars among more grant applicants, including younger ones”.
[An earlier piece in the Chronicle had mentioned that scientists are on average 42 years of age before they get their first NIH grant. Got to keep those young Turks in their place, kowtowing as “postdoctoral fellows” to us experienced gurus; otherwise, who could we get to actually do the work in our labs?]

Robert Merton, founding sociologist of science, long ago identified the “Matthew Effect”:

For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.
—Matthew 25:29, King James Version.

It’s not new, in science, it’s just become as egregious as Credit Default Swaps and other scams. I usually resist the notion that there exists a self-interested, self-serving Establishment, be it in government or in education or in research. But facts are stubborn things, as they say, and sometimes my naivety bows to them. Dr. Zerhouni and the other “NIH leaders” have certainly provided us with some very stubborn, unpalatable facts.

Unorthodox views get no shrift in science

Those who become AIDS Rethinkers, HIV Skeptics, HIV/AIDS “dissidents”, typically become almost immediately astounded at how the mainstream ignores the facts that disprove the HIV/AIDS hypothesis: How can this be!?! This isn’t how science is supposed to work!!

The same astonishment has been experienced by independent thinkers in other intellectual areas. A recent book recounts the experiences of a range of physicists and astronomers and others who found that their work became anathema as soon as it transcended the accepted paradigm:

Against the Tide: A Critical Review by Scientists of How Physics and Astronomy Get Done, Martin Lopez Corredoira and Carlos Castro Perelman (eds), Universal Publishers, Boca Raton, Florida, USA. 2008. 265 pp.

A recent review (againstthetidecurrentsciencereview in Current Science, 95, 25 November 2008, 1485) indicates how similar the experiences of these scientists are to what AIDS Rethinkers encounter:

“This book deals with the tension between the scientific establishment of a given time, and scientists with radical or heretical ideas, who work outside the mainstream, and have difficulties in having their ideas accepted or even seriously critiqued. . . .  much of the scientific activity at the present time confirms [sic] to a set of ideas and paradigms which are unquestionably accepted by the vast majority of practising scientists. Most work is done within this framework, and those who disagree with it find it difficult to survive academically, because they are denied grants, positions, research facilities like observing time on telescopes, invitations to speak at conferences, the opportunity to publish in the best research journals, and even to post their papers on open electronic archives heavily used by the community. These difficulties make it impossible to air radical ideas, or glaring inconsistencies in experimental or observational data, which challenge the very foundations of mainstream science. This suppression of dissent and challenging new ideas, without examining them carefully for correctness and applicability, prevents progress in human knowledge, and the vast resources expended on science go in vain, merely perpetuating unqualified beliefs and dogmas. . . .  The book should be read by everyone working in science, to become acquainted with the anguish that some people feel at the way they have been treated by the scientific establishment, and their to publish their ideas and have them criticized or accepted in a normal way. It is possible that readers may find in these thoughts echoes of the dissatisfaction which they may have felt from time to time, even while working within the system. Or better still, some may be prompted to ponder over the injustice they may have meted out to those in their charge.”

Another review, againsttideinfiniteenergy80review, is in Infinite Energy,  a journal that publishes heterodox material about alternative energy sources, especially “cold fusion”, which is now more usually described as “low-energy nuclear reactions” (LENR)  or “condensed matter nuclear science” . The most up-to-date information about this can be found at New Energy Times and a number of other web sites.   “Cold fusion” was almost immediately dismissed as pseudo-science a couple of decades ago, but hundreds of researchers have continued to investigate the tangible indications that there  is some unrecognized source of energy waiting to be tapped.

Google offers a preview of “Against the Tide”,  which can be downloaded free in a pdf version.

(Full disclosure: the book reprints my essay on “Ethics in Science”)