Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.
In his eye-opening talk, "What Doctors Don't Know About the Drugs They Prescribe", doctor and epidemiologist Ben Goldacre shows us the ways in which researchers can, and often do skew the data in studies, particularly those conducted in trials funded by the pharmaceutical industry, in order to influence the perception of their products. He points out that often times as much as half of the data is missing because the researchers typically do not publish the results of negative studies.
In absence of the full picture, doctors and the public can easily fall pretty to the idea that a particular drug or treatment is effective, when in fact, the data would say otherwise. This is a serious problem. It is not a matter of simply persuading people to buy a new wrinkle cream. In many cases, particularly in the case of heart medication or cancer treatments, it is the difference between life and death.
Dr. Goldacre highlights several ways evidence can be distorted. Among them is the use of authority. Our tendency to obey authority can make us susceptible to buying into claims made by those with a few letters after their name. Although intellectually we know that authority or the perception of it, does not in itself mean anything, our human tendency to obey goes back to the experiments conducted by Yale University social psychologist, Stanley Milgram. In 1961 he conducted a series of experiments which measured people's willingness to obey authority figures. Milgram summarized the experiment in his 1974 article, "The Perils of Obedience", writing:
"I set up a simple experiment at Yale University to test how much pain an ordinary citizen would inflict on another person simply because he was ordered to by an experimental scientist. Stark authority was pitted against the subjects' [participants'] strongest moral imperatives against hurting others, and, with the subjects' [participants'] ears ringing with the screams of the victims, authority won more often than not. The extreme willingness of adults to go to almost any lengths on the command of an authority constitutes the chief finding of the study and the fact most urgently demanding explanation."
Another is the classic advertising tool, playing to known beliefs and expectations. Many studies do not even use relevant subjects, dosages or study designs, but the average person may only see the headline or title of the study and even doctors often do not read more than the abstract or results section.
This is a big deal. Unless we take a critical eye towards our worlds and determine what the data points really mean, we can easily fall prey to partial truths and pre-formulated perceptions. Dr. Goldcare describes this sort of Darwinist dance of ideas as a welcome and expected within the epidemiological community, as the way to surface the best ideas.
There are several forces at play here and while we may expect this type of gate-keeping in media, big business or politics, science is supposed to provide a foundation of knowledge, providing important information to practitioners and the public that will progress society.
When considering various spheres of influence, in society our consciousness is colored by the subjective values and motivations of those in charge and we have come to expect this from institutions such as media and big business. However, scientific research carries with it a larger responsibility. -- Toni Miller
I would hate to think the role of research publication is predominately a space to market pharmaceuticals. When considering various spheres of influence, in society our consciousness is colored by the subjective values and motivations of those in charge and we have come to expect this from institutions such as media and big business. However, scientific research carries with it a larger responsibility.
Scientific research is supposed to represent the epitome of objective truth, free from bias, a source of concrete reality. The whole point of conducting research using the scientific method is to investigate phenomena, and based on the results, new knowledge is acquired and/or what was previously known is corrected. The point is progress.
At the end of his talk, Dr. Goldacre says "sunlight is the best disinfectant." This is similar to thinking about innovation. We have to question ideas openly, with the intention of finding out what works and what doesn't work in order to get to the best outcomes. To enable this, we have to get past the idea of failure or wrong ideas and use each experience and trial as just that; an experiment.
However, when we learn that a significant enough number of studies are not published, it drastically skews the validity of the evaluation. As the body of published literature fails to paint the entire picture, eventually the gap between reality and what we think is reality widens. The negative results are still pertinent for several reasons. Firstly, knowing what has and has not worked in the past and what is/is not working, saves money, time and doubling up on efforts. This also increases the likelihood that something that is not working will not be prescribed to patients.
Several bodies have attempted to regulate this, with no avail. Perhaps it needs to be addressed from other angles. The beauty of a forum like TED is that we get to elucidate, explore and reality-test ideas such as this. What are your thoughts?
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