Trust the Science An Editorial

Over the past three years, we have heard the phrase “trust the science” repeated over and over again by doctors and the media.  But what does this really mean?  What is science?  How do we get to the truth?  Who do we believe?  Is science really the real truth?  Or not?  Where is integrity?  What is integrity?  Where is integrity in research?

During COVID, doctors and lay people alike were led to believe they were not allowed to question the agenda or the common sense of the agenda.  If they did ask questions, they were silenced or shunned.  If the “standard of care” laid out by the government was not followed, doctors could and did lose their licenses even though patient care was not compromised and, in some instances, became better care.  The culture of critical appraisal, once the basis for science, seemed and seems to be missing.  The phrase “trust the science” meant “trust the science coming from a few at the top and do not ask questions.”

The majority of people were told to accept what the government was saying as truth without the government officials providing the “science” or research supporting their statements.  This promoted people’s blind acceptance of what was being told to them without asking questions and without officials or “experts” having to justify their answers with research supported statements.

What is Integrity?  How is it Different Than “Truth?”

Variations of the definition of integrity exist:

• “The quality of being honest and having moral principles.” (Oxford)
• “Firm adherence to a code of especially moral or artistic values; an unimpaired condition; the quality or state of being complete or undivided.” (Merriam-Webster)

Integrity at its core is “being whole or complete, unbroken, unimpaired, sound, without normative judgments.”  It is not about being right or wrong and in this sense does not entertain morals or ethics which can vary according to different belief systems.  Integrity, then, is being true to your word and is a necessary component of workability.

Truth is a perceived declaration.  Often one sees “truth” as the exact opposite of another person’s “truth” concerning the same scenario.  It does have a judgmental component to it.

Integrity should be the foundation of medical research.  An article from the National Institute of Health (NIH) National Library of Medicine states the importance of maintaining research integrity as there is “considerable potential for conflicts of interest.” “Ethical integrity in the conduct of health care research is essential for maintaining the public trust and support of such activities.  Without research, health care cannot advance in a scientific fashion…The ethical management of risk is a primary focus of maintaining integrity in research.”

Published in an editorial in the British Journal of Medicine on the topic of loss of integrity, “It is becoming hard to differentiate real science from marketing, good studies from bad. Many people no longer trust medical science.”

“Scientific Consensus” is Often Not Truth

Physicist Richard Feynman is quoted as saying, “Science is the belief in the ignorance of experts.”  People are led to believe science is truth but in actuality it is ever changing.  Science is doubt-driven, fueled by constant revisions of research and ideas.  Previous evidence is revisited as new evidence is presented.  The art of medicine is the careful interpretation and questioning of the evidence.  We must seek the truth in the available evidence.  Then again, can we trust the “evidence” given to us?  The process must have integrity at its core to be complete and whole.

We have seen how difficult it is to change a medical “truth” even after it has been proven false.  Thought forms suddenly take hold as belief systems become “standard of care,” then become law in a court of law even though “standard of care” may not be the best care for a patient.  These belief systems become difficult to up-root.  Even when scientific evidence shows it is time to change the “standard of care” and change our minds and approach, many have trouble doing so.  We have seen this play out over and over, polarizing medicine in which patients are the ones to suffer and pay the price.

Current Examples of “Scientific Consensus” Not Being the Truth

Examples of this phenomena have been posted in previous blogs, over a range of topics.

1. The Women’s Health Initiative (WHI) ignored estrogen’s benefits by claims that were misleading, wrong and initially exaggerated.  Despite corrections years later, many doctors still reference the WHI as reason to advise women against HRT.
2. The integrity of published medical literature continues to be questioned with Testosterone replacement therapy (TRT) in men as a clearly flawed study published in the Journal of the American Medical Association (JAMA) claiming TRT is dangerous was requested to be retracted by 20 medical societies and more than 150 world experts and yet remains in the literature and continues to be cited as truth by the majority of physicians.  It has not been accepted as standard of care.
3. The idea prostate cancer is caused by using exogenous testosterone and testosterone should not be used if you have prostate cancer has now been refuted and scientific literature has been presented to the American Academy of Urology multiple times to prove testosterone does not cause prostate cancer and may increase quality of life in patients with prostate cancer.
4. Myths and fear of vitamin D toxicity started in the 1940’s and is still promoted today even though the scientific literature is sparse at best when trying to define vitamin D toxicity.
5. Antidepressants have been called into question with significant safety concerns, risks and questionable evidence of effectiveness.  The side effects of homicide and suicide are mentioned as an aside and yet in a majority of mass shootings, the shooter is on these medications.  Should the doctors be held accountable for these disasters?
6. Similar concerns for short- and long-term safety and effectiveness of COVID vaccines have been called into question leading doctors worldwide to call a global stop to Covid vaccines as it is a “reckless gamble” of people’s future health and lives.

These all call to question the integrity of medical literature and produce a cautionary tale of how it can take decades to correct an established medical “truth.”  We must always be willing to ask valid questions and seek the truth with integrity– not just the doctors but also lay people. Many are led to believe they cannot question the “experts.”  Media headlines on any topic are typically written to incite heightened emotion and often fear in people.  We must transform those emotions and fear into curiosity and ask valid questions and seek the integral truth.  Why can the CDC publish statements without referencing scientific evidence when doctors cannot?

Is “The Science” Simply a Measure of Prevailing Bias?

Stanford physician-scientist, John Ioannidis, MD, PhD, pushing for better science to make informed decisions, published an article entitled “Why Most Published Research Findings Are False,” showing most claimed scientific research findings are false.

“Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true…claimed research findings may often be simply accurate measures of the prevailing bias.”  Research bias can be non-financial and/or financial.  Drug makers have a vested interest in the results of their drugs and spend a lot of money marketing them.  The media pushes these drugs for the drug makers.

Insurance Companies, Pharmaceutical Companies, and the Media

A study published by America’s Health Insurance Plans (AHIP) looked at the 10 largest pharmaceutical companies by revenue in 2020, showing more money is spent by drug makers on selling and marketing than on research and development (R&D) of the new drugs for 7 out of 10 companies.  This study showed advertising and selling exceeded R&D by $36 billion which is 37% more than what is spent on R&D.  This was amid the COVID-19 pandemic when the “focus” was on the development of new treatments and the vaccines, in which safety and effectiveness is questioned.

In 2020, 75% of TV advertisements were for pharmaceutical drugs. A statistic said to have increased since.

Pharmaceutical companies pay the media an estimated $6 billion a year on advertisements directly targeting consumers, a statistic from 2016 that has likely increased since.  This is a 360% increase since 1997 when the FDA first allowed pharmaceutical advertising to consumers.  Surprisingly, most countries ban drug makers from marketing prescription drugs directly to consumers.  Only two countries in the world allow this – the United States and New Zealand.  Why?

A study published in JAMA looked at 150 prescription drugs with the highest US sales in 2020, showed drugs with a higher amount of spending on advertisements to consumers were associated with lower added clinical benefit.  Who is the beneficiary here?

Conclusion

It has been long known, statistics in research can be used to promote a bias.  In medical school we were taught how to find biases in research.  Doctors would present articles in their specialties citing exactly how a study was executed, its drawbacks, its biases, the conclusions and the validity of those conclusions.  It was often not black and white.  A journal article could be used to defend a treatment in opposite ways depending on whether one looked at short term results or long-term results.  This happened to me as an intern when I transferred from one institution to another.  It was an eye-opener as two different institutions promoted two opposite treatments based on the same journal article.

It is up to all of us to ask valid questions and seek truth and integrity for ourselves.  We must reignite the culture of critical appraisal.  We all have our own “truths,” biases and belief systems, and we scurry to gather evidence to support what we believe.  We need to free ourselves of our biases so we can see what is being presented and maintain integrity of science’s explorations.

Health Care in The Future

To have an open mind, looking at possibilities, and making decisions for ourselves in our own health care, should be a priority for everyone.  Just because you may not have a medical degree doesn’t mean you don’t know anything or can’t learn anything.  Read the research by putting NIH, PubMed, or Nature after your google questions, this will bring up the research articles.  Everything else on the internet is an opinion.  Ask questions of multiple people with differing thoughtforms, and decide for yourself what makes the most sense in your personal health care.

Your health is the most important thing you have!

Your health is the most important thing you have!

Your health is the most important thing you have!

Your health is not about going to the doctor and being told what is wrong with you and getting a drug or to be told nothing can be done for you.  Good health is not about treating yourself with only those things for which insurance pays. 

Health is about learning what your body has to say to you, what your aches and pains mean and how to get rid of them, finding out why your body is not working well, and finding out what you can do to be and stay healthy.  Health starts with exercise, good organic non-toxic food, a resilient positive attitude, and a passion for taking care of yourself.

Having your health is about claiming your right to your own healthcare, not just accepting and believing what a government or insurance decides is the best for you and your health when they don’t know who you are as an individual and what you, in particular, may need.

Take back your right to your health care.  Take back your health.

Have an awesome day.   Dr D