Monday, April 30, 2018

TRUST BUT VERIFY

At the heart of medicine is the expansion of knowledge and its governance. Let us explore that a bit as we go along on this journey together…

First imagine forcing a cotton thread through the eye of the needle; the fibers catch the sides of the eye and the thread twists and turns making the progress difficult. Science too works through fits and starts, from moments of eureka to utter despair. One cannot force a braided thread through an eye of the needle that does not cater to those dimensions. It is akin to forcing a square peg through a round hole. Dimensionally, that is a challenge. So, first some elation; these are some of the tales of human ingenuity forged through diligence and perseverance …

The first part of knowledge is an old streaming phantasmagoria of the past; an acquired information that is understood and then verified. Take Marie Skłodowska (Marie Curie) for example; only one of two people in history to have received the Nobel Prize in disparate fields of physics and chemistry. One has to look at two other greats in science who paved the way for her discoveries; Wilhelm Roentgen discovery of X-Rays in 1895 and Henri Becquerel discovery of the penetrating powerful rays from Uranium salts. From those humble beginnings and pitchblende arose Radium and Polonium via differential crystallization. All in all, a magnificent feat of human endeavor!

Marie Sklodowska


Another simpler time brings back a past shared by a certain Edward Jenner, who through keen observation had determined that milkmaids were somehow immune to Smallpox. His assumption was that the pus from the blisters on the milkmaids’ hands were rendering them immune. Harkening to his mentor Sir William Osler’s advice, “Don’t think, try!” he inoculated an 8-year old James Phippes, the son of his gardener with cowpox and rendered him immune to Smallpox. During the 18th century Smallpox had decimated 20% of the population. In 2015 through vaccination, we have extinguished the disease.

Edward Jenner


Now a couple of tales that don’t get out of the bathtub and make you run naked through the streets…
Top among such human foibles is the Tuskagee Syphilis experiment. Between 1932 and 1972, 399 impoverished individuals with known diagnosis of Syphilis were observed without available treatment to determine the disease progression and timeline. ( Here)  Or another in the name of science was the Japanese experiments during WWII on native Chinese inducing vivisection without anesthesia, induced gangrene, live weapons testing, germ warfare infections, and other such macabre testing in the name of science.  While the story of Thalidomide and children born with phocomilia is well known, ( Here ) there is little heard about a 2007, drug trial with THN1412, a leukemia treatment that caused significant harm and death to the participants.( Here ) Josef Mengele’s experiment on eugenics and twins is another lasting memory of despair.

Tuskagee victims


What would make humans conduct such experiments? It boggles the mind. Yet as the Stanford psychology Professor Philip Zimbardo’s prisoner experiment clearly shows humans when given the power use it without discretion. And to further the damage the ones treated as prisoners develop varied forms of the Stockholm syndrome; acceptance! ( Here )

Today most of the “science guys” are happily running with the banner of “Optogenetics” (modifying the cerebral genes into being switched on and off, on demand. ( Here ) We think of the Large Hadron Collider as a means to discover the “Big Bang” and in doing we as yet have not mathematically or through physics determined whether we might create an abyss that has its own virtual event horizon.
In medicine (you knew I was going to go there, weren't you?) there is the newest version of experimentation that seems to have ignited the mind of the scientific world. This experimentation arrives at us through the aegis of the Economists. To boot they seem to have a predilection to the Keynesian world of thought…It starts and ends with costs!

The driver of today’s experiments is money, period! There is little in the name of patient care and benefit and more in the purpose of costs. Our focus has shifted from one of curing the maladies of yesteryear and today, to the potential only of saving dollars. The louder the cry, the more the economists and their agents seem to be benefiting from such diatribes. They seem to point fingers as they gather large reals estates and flashy, fancy cars, all in the name of public good. The scientific journals are filed with jargon and meaningless pseudo-intellectualism.

Pyramid
to

The Statin era that created a 20-year enrichment cycle for companies is now falling by the wayside as patents expire and eggs and cheese are no longer considered the bad foods. The “Food Pyramid” once touted by the USDA, the American Heart Association and by the experts in various scientific literature is now flattened into the “Food Plate.” The “Food Pyramid” probably has to share some responsibility in the Obesity epidemic of the 20th and 21st century- if you were inclined to think about it further. ( Here )


                                                                      ....Plate

As we mightily profess the wonders of End of Life discussions in a myriad of ways that exposes all the virtues of Tantalis, we seem to forget in those many ways how it is to Live our Lives; to take care of ourselves rather than be dependent on the most mundane of newest "studies" that this potion extends survival and that pill rips your rectus abdominus. That, there is fear boiled into every moment of our living by the many informants, is the curse of  this information age! The asymmetry of information is forced upon us as reality. The Orwellian doublespeak is over-polished and rules our days and nights.


1. Learning from history is good if you are not blinded to repeat the past. The answers lie in front of us.

1.     2.  If you experiment use basic science, not the fiat of correlational junk science. Use the correlational data to go further through verification from basic science.

2.     3.  Use the p-values more for the next step in validation rather than as an incontrovertible truth.

3.    4. Expose the economists at their own game…follow the money trails. Fiat (not the car) by any other name is fiat!

4.      5. Always have the goodness for the human, in human experiments, in your thoughts.

5.      6.  Refrain from using experiments as a means of self-enrichment. They eventually get found out and fame is replaced by infamy. Good science will bring its own rewards.

6.       7. Think how to advance the knowledge without harm when you conduct experiments.

And as one very smart person once said, “Trust, but verify” both in human affairs and in science!