Monday, October 12, 2009

Self-Serving Fictions

Scientific papers are polite or self serving fictions in their statements about doing science: they are at best logical reconstructions after the fact written under the conceit that fact and argument shape conclusions by their own inexorable demands of reason. Levels of interacting complexity contradictory motives thoughts that lie too deep for either fears or even self recognition all combine to shape the most complex style of human knowledge.
-Peter Medawar 1915-1987 Nobel Laureate in Physiology/Medicine for transplant graft rejection and acquired immune tolerance.

The passage of days is like the summer’s breeze, warm and comforting, full of promise, gifted with light and stealthy. It flows freely and with haste, quick without a return thought, gone before you know it. It becomes a prisoner to the unmoving mover; time. Looking back seems a grander path with memories rich and poor, big and small, grand and simple, all called in for compaction into a molded thought or remembrance. Memories thus become the ghosts of the departed past.

Looking forward the limit of time haunts with that knobby, gnarly and crooked skeletal finger poking its ugly joints from beneath the black cloak, flexing the message of the end of time. It is here amidst the magnetic pull of the past and the dour finality of the future where the mind resolves to cut its losses and come clean.

Now 89 years old and resting comfortably in his arm chair with one hand twirling his reading glasses and the other comforting the sore achy joint of his knee, he seems on the verge of saying something. The plaid green terry cloth robe covers his thin, stiff and slightly bent body. The limit of flexibility and the loss of elasticity conspire to evoke a sigh from him. He leans back against the armchair and another weak sigh escapes his lips.

“You know,” he finally says, “I was about your age when I headed the department. It was always chaos. It was fun arbitrating between two or more egos. That taught me a lot.”
“Its still the same.”
“Oh yes human nature never changes you know.” He leaned across to the table for the glass of water. His motion was slow and deliberate. No hurry, time was here to be used and suffused with events. Satisfied with the swig to wet his mouth he leaned back again. “I have to tell you a few things that I have never mentioned to others. I believe given the shoes you are stepping into you should know how to navigate from my experience.”
Closing his eyes and drifting into his memory with the eyeglasses still twirling steadily in a gentle defined arc, he said, “Nothing ever is what it seems. Even some things that are certain in all respects from scientific and all academic points of view to be truth are barely so.”
“How so?”

     Gastric (Stomach) Ulcer

“Take for example the peptic ulcer story. You know I was on the board of editors of a prestigious medical journal. There wasn’t an issue that went by not hosting an article crying the benefits for the acid reducing drugs like Tagamet and Zantac. Study after study showed that the peptic ulcer therapeutic drug of choice was one of these two contenders. The harder each pharmaceutical company tried to one up-man-ship the other with a new study every month. In reviewing these articles we lost sight of trying to understand the real cause of the ailment. Oh yes it was acid, reducing the acid load in the stomach ameliorated the symptoms. Bingo cause-therapy-benefit case closed. The two ‘pharmas’ however not wanting to cede dominance to the other fought the battle of wits with scientific articles, each showing some secondary benefit it could delineate from the study design. On looking back those articles were based on elegant acid level reductions and quality of life and symptomatic relief. Except for the first part the other two were extremely subjective and hence the answers were molded by the questions asked. Percentages and graphs of every kind and Log charts and pie charts and what have you filled the pages of the journals to quantify, verify and thus confirm as facts the premise in the abstract up front that most doctors really find time to read.” He fell silent for a bit. He raised his finger before his voice, “And where do you think the real answer came from?”

“Absolutely. In 1982 it took two little known doctors, Robin Warren and Barry Marshall, with open minds, unencumbered by the prodigious and turgid literature of self satisfied authorship, became the stewards for the new generation of physicians in how to treat peptic ulcer. Facing rejection after rejection from the editors of medical journals, the ossified thinking of the establishment finally relented to the pressures of pure science.”

Helicobacter Pylori

“Didn’t they get the Nobel Prize?”
“Indeed. And Marshall drank a glass full of Helicobacter Pylori to create an ulcer in his own stomach to prove his point. Damned near killed him. Now that is a pure scientist.” His head bobbed slightly to the tune of his brain’s inner electrical dialogue. The aging process was in full metal jacket, slowly advancing on his realm.

He refused all help as he slowly got up from his chair and headed to the desk in the corner of the living room. The desk was covered with neat stacks of journals. He searched for one and retrieved it. He slapped it on the desk to remove all dust that might have taken shelter. No plumes arose from his action.  He made his way back to the chair and sat down once again. The entire movement was an echoed cacophony of groans.

“This one is what I am most disappointed in and probably was most proud of.” He proclaimed.
“What is it about?”
“I authored this thirty years ago. The fellow rotating through my service actually wrote this article and he was a convincing sort of character. He later became the head of department at a university. He gathered data from our hospital with about 30 or so patients used a crafty statistical methodology and came up with striking percentages that made our point of one treatment was far superior to the other in moderate grade Lymphomas. With graphs and all sorts of supporting materials he showed the data to be bullet proof. We sent out the article, with my name, it got the editor’s attention and with his ingenuity it got published. That article made him the celebrity in various medical meetings and added to my star shine which at that time was at its peak.” Again he fell silent as the tremors increased slightly probably from the agitated state of his mind.

“I remember, the multi-institutional study three years later disproved the premise and found both treatment regimens to be identical.”
“Yes.” His voice barely above a whisper, he put the journal down. “From ill-gotten pride to well deserved rebuke.”
“But no one ever questioned you. You wrote hundreds of other pioneering articles on various subjects.”
“I did. It taught me never to apply pseudo science and new-fangled gobbldy-gook charts to medicine or anything.” He reached for his glass of water to douse the flames of his internal struggle.
“You have accomplished much in your life. You should be proud of it.”
“Accomplished, yes. Proud, never! It reminds me of the  Piltdown debacle in England.”


“Yes, in archeological circles it was the most egregious duplicitous find ever. A guy named Dawson along with two other collaborators managed to fill a ditch with the skull of a human and the jaw of an ape with teeth of an Orangutan. He then proclaimed to have found a new evolutionary step in the species. This was in 1913. It was not until 40 years later that the truth came out to the chagrin of many respectable archeologist who had used that imagined intermediate evolutionary construct to theorize their point of view.”

Charles Dawson is #3 from left in the back row

“I didn’t know that.”
“Yes, remember prevaricated data causes inventive constructs to keep the lie forged and moving forward. Truth on the other hand guides us on the straight and narrow.”

The evening ended with little further remorse. His mind seemed purged from the disease of self-flagellation. His one miscue made him a better person, a more cautious scientist and a better physician of physicians. The ever-burning flame of self-doubt now doused by the tale he had told comforted him. Inner peace smoothed the wrinkles and frowns grown wild from a single event.

In the end however reticent, the truth does triumph even if it is not with all its pomp and glory. If it cannot be now, yet it will always come

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