GELFAND OFF THE CUFF-Greetings at the beginning of this truncated holiday week with some truncated thoughts --
The esteemed writer John Simon was speaking in Los Angeles a number of years ago. In his opening remarks, he drew a line between what he called a reviewer, obviously a lower form of species, and a critic, by which he obviously meant the few people as thoughtful as himself. He began by pointing out that reviewers tended to like most of the movies they see, whereas a critic only likes perhaps one out of ten. There is an analogy, however stretched, to be made between Simon's remark and how one defines the gulf between real science and pseudoscience, because the former requires hard thought, whereas the latter doesn't seem to require any thought at all.
A few years ago, the University of Pennsylvania medical school joined in an effort to present the latest findings on medicine and science. The website they created is known as MedPage. They are particularly known for sending knowledgeable writers to the major medical and scientific meetings, and relating what is reported there.
The regular Medpage reader begins to notice something after a while: A substantial portion of the stories discuss the failure of a new drug in clinical testing, or the failure of some touted new treatment to work better than the older accepted treatment. Here are a couple of examples from a recent edition.
"DALLAS -- A trial halted for harm with the novel anti-inflammatory lipid-lowering agent varespladib raised major ethical concerns when the sponsor failed to follow most of the patients afterward."
You have to admit that's a pretty negative finding. Here's another:
"Colon cancer patients who used low-dose aspirin after their diagnosis didn't see an increase in survival time, researchers found." If you go on to read the article, you will find a careful discussion which mentions the limitations of this study (as explained by its authors), mentions previous studies that sometimes drew the opposite conclusion, and an attempt by the authors of the study to resolve the conflicts between various studies.
In other words, in real science, things can be complicated, the answers are not always clear cut, and the scientists themselves are the first to point out that important questions remain to be answered.
Real science insists on making clear the failures as well as the successes. Within a context of honesty, it's easier to give credence to the successful studies. For example, one finding in the same issue of MedPage is that a new drug provides some benefit in advanced thyroid cancer. Another suggests that postmenopausal women would be advised to avoid drinking a lot of sugary drinks if they want to avoid endometrial cancer, because there appears to be a correlation of the one with the other.
MedPage also provides the opportunity for its readers to offer comments on the articles. In the article about sugar and endometrial cancers, the comments range from a skeptical remark suggesting that the correlation doesn't prove causation, to other comments that there could be a causal link, to a detailed discussion of the biochemical pathways of sugar metabolism. (As a onetime teacher of biochemistry, that one really took me back!)
And then there is the alternative. There is a fashionably cynical point of view that seems to be increasingly common. It argues that the pharmaceutical companies, among the most wealthy and powerful corporations this side of big oil, control medicine, the politicians, and publications. There is undoubtedly some truth to the assertion that pharmaceutical corporations have lied and deceived (and they certainly have way too much political clout), but when you read MedPage or attend a scientific meeting, it is hard to resist the observation that there are lots more honest scientists in the world than dishonest.
The fact that expensive clinical studies are reported to be failures should be the best evidence that the system usually works. We don't get the last word from the first study, but when a highly touted new drug is tested, and the doctors who did the study stand up in public and report that there is no statistically significant difference between the touted new drug and the old, cheap standby, that should warm the cockles of our respective hearts at one level.
It's obviously not a perfect system, but like the old line that democracy is the worst political system except for all the others, science as it is practiced is probably the best we can do in real life to tease out the truth about natural phenomena and to make progress.
I bring this up in order to talk a little about pseudoscience, and in particular the deceptive claims made by hucksters. When you look at the back page of the tabloid at the supermarket checkstand, you don't see a skeptical analysis of the merits of the latest wonder-cure being advertised. Instead, you get a lot of generalities about how it is associated with heart health and staving off senility, or that it is guaranteed to strengthen your immune system.
Actually, that claim about strengthening the immune system is probably the single best guarantee that you are looking at hucksterism and quackery. That's because medical science has lots of carefully developed data about heart health, so wild claims can be evaluated. For the immune system, not so much. For one thing, the immune system fights a lot of things, and has to balance the needs of one type of surveillance vs those of a competing form. I'm not talking about the well known immune deficiencies, some of which can thankfully be treated. But the immune system can be too strong, in a sense, and attack our own bodies in what we call autoimmune disorders.
For most of us, the immune system is working just fine most of the time, because we are not perpetually walking around with fevers and boils. And when we do get something, the immune system generally functions to make it go away. Why try to change something that is working correctly?
In other words, filling a bottle with an herbal supplement and claiming that it strengthens the immune system is not terribly informative to the buyer, because the words could mean just about anything. But that's what you see time and time again in pseudoscientific ads for unproven folk remedies.
At the risk of typing a little flippantly, I can state honestly, scientifically, and rationally that the flu shot I just had will strengthen my immune system. But it is strengthening it in a very specific way, by allowing it to be prepared to deal with the real flu virus if I should inhale it or drink it.
One of the clues for pseudoscience is the fact that it is presented in such a self righteous manner, sure of itself and unaccepting of doubt. Compare that to the long list of failed treatments and so-so reports on new pharmaceuticals noted in MedPage, and you will get an idea of which side is being intellectually honest, and careful about its findings. This is not to defend the congress for giving the pill makers everything they want when it comes to patents and billing, but we need to temper some of our political wrath with a bit of scientific understanding.
(Bob Gelfand writes on culture and politics for City Watch and can be reached at [email protected])
-cw
CityWatch
Vol 11 Issue 95
Pub: Nov 26, 2013