Thursday, April 26, 2012

Fast science: No time for uncertainty

Reading Barbara Ehrenreich's "Bright-Sided" has been liberating in that is has given me permission to let my pessimistic nature out of the closet. Well, it's not exactly that I am pessimistic, but certainly I am not given over to brightness and cheer all the time. My poison is worry. Yes, I am a worrier, in case you had not noticed. So, imagine how satisfying it is for me to find new things to worry about. As if climate change were not enough, lately I started to worry about science.

No, my anxiety about how we do clinical science overall is not new; this blog is overrun with it. However, the new branch of that anxiety relates to something I have termed "fast science." Like fast food it fills us up, but the calories are at best empty and at worst detrimental. What I mean is that science is a process more than it is a result, and this process cannot and should not be microwaved. Don't believe me? Let me give you a couple of instances where slow science may be the answer to our woes.

1. Lies and damned lies
Remember this story in the Atlantic that rattled us with its incendiary message? Researcher John Ioannidis has been making headlines with his assertion that most, if not all, of what we know in medicine is in doubt, given how we do and publish research. And how we do and publish research has everything to do with the speed of "progress." Academic careers are made with positive results, to sell news the media demand positive results, and to respond to this demand academic journals prefer only to publish positive results (this last phenomenon is referred to as "publication bias," and is something Ben Goldacre rails against at length). A further manifestation of this fast science is that "no replicators need apply." I am, of course, referring to an extension of the publications bias, whereby journals are not interested in publishing even a positive study that replicates a previous finding -- this is simply not sexy. Thus, results have to be quick and positive to grab a share of our attention and sell academic prestige, journals and news.

2. Science output to drive business profits
In his book Supercapitalism, Robert Reich describes the growing demand by investors over the last several decades to squeeze ever-growing profits. It is clear that this chase after short-term profits has resulted in job loss in the US through outsourcing, the widening of the economic gap, and even the crash of the world economy following the collapse of the mortgage-backed securities house of cards. Much of the profit can be counted on to come through scientific innovations which may or may not improve our quality of life.
In medicine, where scientific progress is applied to our fragile being, being reasonably sure of our findings seems pretty important. Yet speed is once again the order of the day. I will grant you that speed is of importance in such diseases as advanced cancer, for example, where we may and should accept a level of uncertainty that we would ordinarily run away from in other circumstances. But doesn't it make sense to be much more cautious before broadly accepting an intervention that happens before one gets sick, one that is meant to diagnose either early disease or a precursor to one? Should we not demand slower science before we allow anyone to medicalize such normal events in life as menopause and aging? Should this caution also not apply to screening for diseases that may or may not impact us in the long term, yet the chase could hurt us substantially in the immediate future?
But this is not the way to stimulate the economy or to make a profit. The half-life of a medical device, for example, is less than 1 year. After that a new "improved" version of the device is expected, whether it does or does not improve outcomes. For decades we were told to get screening mammography after the age of 40, only to find out now that the risks of this may well outweigh its benefits for many. The American Lung Association has just endorsed CT screening for lung cancer among current or former heavy smokers, yet the jury on its risk-benefit-uncertainty equation should still be in the thick of deliberations.

3. Science denialism
We hear a lot about how people are turning away from science. The state of Tennessee is about to descend back into the dark ages when superstitions instead of scientific theories dominated the classroom. A strong and largely anti-scientific lobby wants to bury any mention of human-driven climate change; fortunately, it looks like they are not succeeding. The anti-vaccination groups are getting more instead of less vocal following repeated debunking of any link between vaccination and autism. Science denialism is so rampant that there was even a need for a conference on how to address it. What gives?
While blaming everything on fast science alone may be reductionist, fast science in the setting of our growing societal innumeracy is a recipe for disaster, as we are seeing unfold. Our schools have failed spectacularly in their duty to educate kids about the process of science, while at the same time arming them with the "single-right-answer-to-every-question" attitude toward knowledge. This pernicious combination, along with the publication and reporting of sexy science at the expense of the more thorough analytic and introspective approach, seals the impression that the roller coaster of scientific knowledge represents not the very essence of how science should be done, but that science (and scientists) has failed.
Is slow science the answer to this fiasco? Only in part, I am afraid. Without altering fundamentally how we teach science at all levels, it would not be the cure, even if it were possible to execute. No, I am afraid that without teaching what science is, it is not even possible to get it to slow down.

Let me reiterate: the pace of scientific discovery is slow. This does not mean that we need to hide every step of it from view until we get the results that we deem worthy of sharing. On the contrary, I agree with those who think that sharing at the more interim steps can only improve what we do. Yet the innumeracy, fame and fortune are forces that put such free sharing in peril by misrepresenting it as the final answer to everything. And when the answer is changed, which is not only expected, but indeed desired in scientific pursuits, the public opinion punishes science.

Let me end with a quote I read on one of my favorite web sites, Brain Pickings, in a review of the book boldly entitled Ignorance: How It Drives Science:
Are we too enthralled with the answers these days? Are we afraid of questions, especially those that linger too long? We seem to have come to a phase in civilization marked by a voracious appetite for knowledge, in which the growth of information is exponential and, perhaps more important, its availability easier and faster than ever.
[...]There are a lot of facts to be known in order to be a professional anything — lawyer, doctor, engineer, accountant, teacher. But with science there is one important difference. The facts serve mainly to access the ignorance… Scientists don’t concentrate on what they know, which is considerable but minuscule, but rather on what they don’t know…. Science traffics in ignorance, cultivates it, and is driven by it. Mucking about in the unknown is an adventure; doing it for a living is something most scientists consider a privilege. 
So, let's celebrate uncertainty. Let's take time to question, answer and question again. Slow down, take a deep breath, cook a slow meal and think.

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