Monday, October 18, 2010

Ioannidis profile in the Atlantic

Medical scientists are facing the fact that they have an evidence problem, according to this profile.
But some wonder if they should admit that publicly:

Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. 
John Ioannidis, the subject of David Freedman's story (check out his very interesting blog here), says hiding uncertainty is the wrong approach.
We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

I'm reading Bruno Latour's "Politics of Nature" right now, and he pins a lot of what's wrong in this world in our desire for science to deliver the answers relevantly and on time. We (mistakenly) think of the world as divided into two parts: nature and civilization. In civilization we talk a lot, we have opinions, we debate, we struggle over politics. Nature (according to this view of the world) has no talking, it's silent but it contains the truth. The trick then, is to send someone out into nature and bring back the truth to put an end to all the arguments. We call this person "a scientist."
The problem with this is that 1. Even scientists have trouble finding the truth (see above) and 2. They aren't above politics (see above again).
A more healthy system, according to Latour, would be to recognize that civilization is in nature and inextricable from it, and that science is not exempt from politics. He's not denying the existence of objective truth, but instead of saying X-Files style that "The truth is out there" he's saying "The truth is right here" but that we have to be honest about how little of it we can see - which means accepting that politics and debates about who's vision of the world is more correct are an essential part of governing. We can't hope for science to trump politics. Doing so get's us into a lot of trouble.

hat tip to Faith Gibson for sending the story to me...

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