Friday, July 6, 2007

In search of science in medicine

Teasing out the facts

The importance of being able to understand real patterns and realtionships among biological processes has become glaringly critical in light of the innumerable contradicting, supporting, and partially supporting pieces of data available for study in relation to medical outcomes. The lack of more than just a superficial comprehension, even in the medical community, of epidemiology and statistical analysis leaves a huge vacuum when attempting to separate the real from the perceived. Without a working knowledge of disciplines like these, how can we discern what works from what does not?

We are constantly exposed to a “conclusive study” that seems to support the latest theme or idea du jour imaginable. A parade of sometimes knowledgeable doctors, PhDs’, Institutes, and organizations are often hopelessly entangled in an incredibly complicated web of meaning. To make matters worse, many of these official terms (i.e., “Doctor”, “Center”, and “Institute”) have been compromised and do not necessarily represent any type of unbiased source of information. It is very easy under these circumstances to see how even "studied" people can be led astray. It is more important than ever that individuals have the education and the mechanisms necessary to be able to differentiate for example, a quality study from a poorly designed one. Unfortunately, too many people have minimal competence in the nuances of endpoints, meta analysis, cohort studies, quality ratings, and many other analytical skills that enables one to place these findings into proper perspective. Indeed, not to belie the point, even well educated scientifically oriented professionals can find it hard to wade through this quagmire.

Additionally, there is a deficient understanding of how the scientific method sifts information and knowledge, filtering innumerable pieces of information into a meaningful flow of integrated understanding .Science proceeds sometimes haltingly within a communal process, somewhat analagous to a filter funnel where information is sifted through several stages, and where the human endeavor of observation and interpretation, often replete with contradictory claims of truths about the world eventually yields a little trickle of fairly clear understanding. This can be an inexorably tedious and cumbersome process. Understanding how it works, and works so well can be a huge problem.

This problem stems in part from the weak science based education in the formative years of even highly educated people. Ursula Goodenough, professor of biology at Washington University in St. Louis relates that “science continues to be taught from K-12 to the college and university levels, in fragmented, incoherent bits and pieces rather than a coherent narrative, a history of nature.” She adds that “a primary concern is that students come to understand and appreciate both how science is done and some of what scientific inquiry has discovered.”

Another basic concern is that science education, both as articulated in the Standards and as practiced in American schools, basically fails to convey to students what Goodenough refers to as the scientific worldview: a narrative account, with supporting empirical evidence, of current understandings of the origins and evolution of the universe, the planet, and life (including humans), as brought to us from what are often called the historical sciences.”

In spite of these problems, it is critical that this education is done. Goodenough co-teaches a course at Washington University presenting a science worldview and has observed “students report that their interest in, and mastery of, scientific concepts is greatly enhanced when such larger contexts are provided. We’ve become convinced that a robust and mindful grasp of the scientific worldview generates a more abiding commitment to scientific inquiry, to environmental sustainability, and to societal responsibility.”

Another thought is that a significant amount of initial analytical observations and studies may be given unwarranted importance and significance due to misplaced criteria when determining the level of meaningful relationships. According to Colorado State University physicist Victor Stenger, the common level of significance when studies are published in the medical field is at about a p value of p=0.05. The p value has two important caveats to take into account. First, the p value is often misinterpreted to mean the “probability for the result being due to chance”. In reality, the p-value makes no statement that a reported observation is real. “It only makes a statement about the expected frequency that the effect would result from chance when the effect is not real”.

Second, p= 0.05 may be far too lenient a level of significance. It may be time to reconsider the traditional significance level from p= 0.05 to the much more stringent levels of physics researchers of p= 10-4, especially with trials dealing with little scientific basis. This criterion, or something like it, could then be applied within the realm of medical research- especially in those cases that require extraordinary claims not consistent with our understanding of science (Some of the attributed powers of the placebo, the dualistic mind/body and quantum consciousness connections fall into this realm).

At any rate, the scientific medical community is faced with the looming challenge of teaching to a larger public- and to themselves- how the complex cogs of the scientific process reveals natures truths and how they are interpreted effectively and usefully within our human community. If we don't, we run the risk of being victims of our own success.

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