W. Gifford-Jones, MD and Diana Gifford-Jones
Common Sense Health
Having a good debate about matters of your health is not a bad thing. As has been said, “It is better to debate a question without settling it than to settle a question without debating it.” But recently, having a difference of opinion has become too closely associated with the polarized politics that is endemic in many countries. People have lost their sensibilities amid noisy pundits arguing nonsense about facts and fake news.
So if you do not know who to turn to for the “truth”, you are not alone. And maybe you are chasing in the wrong direction.
In the old days, there were fewer authorities holding credible and accessible medical knowledge. Research was bound in books, and it was the “good doctor” who held a monopoly on the practice of medicine. Well trained, experienced and distinguished, it was customary that the doctor could explain disease symptoms and treatments with confidence, clarity, and compassion. Patients could trust the doctor for medical expertise and outstanding judgment in the face of difficult decisions.
Today, even the wisest polymaths on the planet cannot compete with the computing powers that effortlessly generate big data, crunch statistics, run algorithms, and deploy artificial intelligence that can predict problems before they occur. The volume of published research is growing exponentially. To boot, an upheaval in communications has multiplied the sources of good and bad information for patient and doctor alike.
Some old lessons stick. In 1902, Henri Poincare, the French mathematician published Science and Hypothesis in which he argued the absolute truth of science is non-existent. He wrote, “Experiment is the sole source of truth. It alone can teach us something new; it alone can give us certainty.” To appreciate his point, one needs to understand the purpose of research.
The Lancet, one of the world’s leading medical journals, stated nearly a decade ago, in a 2012 editorial on medical research, “Truth in its purest form is rarely apparent. Results are presented not as facts, but as probabilities and uncertainties. The job of medical researchers is to ensure that these probabilities and uncertainty margins are robust—a task that is contingent on the pursuit, not of truth, but of methodological rigour.”
Still, people want answers to their questions. But before jumping to conclusions based on the latest YouTube video or Facebook post, or even the statements of esteemed public health authorities, have a look at the objectives of the research they cite, the questions that have been posed, the quality of methodology, and the communication of findings.
Be cautious about interpreting findings from medical research as rigid facts. The perspective of a statistician will differ from an ethicist when looking at the same experiment. Ask the director of a clinical trials unit if the objective is finding truth. The response will be an emphatic no. Clinical trials are about evaluating an intervention to weigh effectiveness in a controlled experiment.
Reviewing the detailed parameters of research is not a practical pursuit for most. Selection and synthesis is the job of the journalist – and now the public too. People need to be far more discerning in their assessment of information. This means, don’t expect absolutely certainty in the answers to medical problems. Rather, accept that finding truth in science is a moving target. Bertrand Russell, a British Nobel laureate and a champion for freedom of opinion, wrote, “When a man tells you that he knows the exact truth about anything, you are safe in inferring that he is an inexact man.”
The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, email@example.com.