New Threats Against Scientists And Doctors

A million or so years ago, when I was a pre-med, I suffered from debilitating stomach cramps, as many people with irritable bowel syndrome do. I was a student, living in a Chinese immigrant neighborhood in California, and above a bookshop was a traditional (and inexpensive) Chinese healer. I had to fly out in a couple of days for some med school interviews and I figured, “What the hell, what have I got to lose?”

His grandson wrote down my symptoms on a piece of cardstock in Chinese characters and sent it back to the healer. I was called back and he greeted me (I think) and had me sit. He examined my tongue, took my pulses, looked at my color. After a bit he turned the card over and wrote some characters on the back and pointed to the front of the shop.

There, the kid took down a couple of jars of various things—mushrooms, twigs, I don’t know. I went home and dutifully made it into a tea and managed to choke it down. Did it help? Who knows?

Medicine is the most human of scientific endeavors. We don’t just study cells in a petri dish; we apply what we learn to real people, with real lives, real feelings, real autonomy. All we can do is give the best advice we can, and let the patient decide.

But where do we get that “best advice”? We get it from decades of observation and research. Science isn’t the same as “truth”—science is a method, a materialist “practical philosophy”. It assumes that the natural world can be understood by natural (as opposed to supernatural) explanations and processes. It rests on undying curiosity and a desire to find a real truth.

But it is very much a human endeavor. Our own biases are always there, coloring everything we do. For decades, doctors made decisions about kidney health based on two sets of numbers—one for African Americans, and one for everyone else. It turns out that the science behind this was obviously flawed but our own societal and personal beliefs kept us from questioning it, until recently. It’s hard to know how many people went on dialysis or died because of our failure, but it’s likely a lot.

The Chinese healer I saw presumably brought his own compassion, observations, knowledge, and biases with him to my appointment. What he didn’t bring was a century of scientific research, which is a necessary component to helping patients.¹  

Scientific research is at once beautiful and brutally ugly. When you choose a question to investigate, you assume that your hypothesis is wrong (the “null hypothesis”). If it turns out you were correct you win, right?

Not so fast.

You research isn’t considered true until others try to disprove it as well. An idea has to stand up to the harshest scrutiny. And that’s just how it goes. In 1998 when The Lancet published a paper by Andrew Wakefield alleging that vaccines led to autism, they felt it met their standards. The years were not kind to that decision. The self-correcting process of science eventually led to the paper’s retraction and destruction of Wakefield’s reputation and career. Unfortunately, this didn’t happen before horrific damage was done to the public’s trust in vaccines.

But that’s how science works. We don’t make unproven assertions and take them for truth. We have to bring receipts. It’s a tough process, which makes the latest developments from the Trump Justice Department so bizarre and frightening.

Over the last week, a number of prestigious medical journals (including the New England Journal of Medicine) have received frankly bizarre threatening letters from the DOJ. The one that I have the text of was signed by Edward Martin, the US Attorney for the District of Columbia. He addressed it to the editor of Chest, a top flight journal that publishes research into diseases like tuberculosis, asthma, COPD, lung cancer.

From my perspective as a physician, the letter actually doesn’t make a lot of sense, but what is does more than anything is show how deeply ignorant Mr. Martin is of the scientific process. He asks questions like how do you address potential conflicts of interest, and do you accept articles from competing viewpoints, and how do you handle allegations of authors misleading readers.

If he had ever read medical journals, he would already know about the mandatory statements of conflict of interest; about the brutal process of review and scientific scrutiny; about rooting out fraud and misleading papers (an imperfect process to be sure).²  

If I am to be generous and assume Martin actually understands this, then the letter has only one clear purpose: intimidation.

The administration has already made it clear that it disapproves of research into topics it doesn’t like, such as medical disparities in gender, race, sex, etc., topics actually vital to the practice of medicine as I mentioned above about race and kidney disease. This is a ham-handed and doomed-to-fail attempt to make medical journals into mouthpieces of the Trump White House. (I would have the exact same critique if any party had launched this insanity.)

About a year or two ago, my office updated its intake forms to, among other things, be more gender-inclusive. You can now state your gender, preferred pronouns, etc., and you know what? It payed off within days. Patients thanked me for seeing them, for honoring their basic human dignity. (It also pissed people off, but they will have to get over it.)

Here’s my fear: some idiot at the Justice Department will realize that medical offices receive payments from the federal government. Then they’ll draft a poorly-written but deadly serious threatening letter to me demanding that I return to my non-inclusive intake forms, under the penalty of driving me out of business.

I don’t think that the world’s most important medical journals will be easily intimidated (and neither will I), but this chilling attack on science will still have far-reaching effects. Stay tuned.

Stay well

-pal

1  This isn’t a dig on the healer. Traditional Chinese medicine is a strange beast. It has some elements of traditional folk medicine, but a large part of it was developed under Mao to promote Chinese Communist nationalism, and to deal with the shortage of doctors who practiced Western medicine, which Mao preferred for himself. Modern medicine draws on centuries of observations and traditions, but tests them to see if they hold up to modern scientific scrutiny. In other words, we ask, “no matter where the ideas came from, does it work?” For example, artemisinin, a plant derivative, was used in Chinese herbalism for centuries, and then re-discovered when the Chinese Communist Party started screening plants for anti-malarial compounds. Artemisinins are now a crucial tool to fight malaria.

2  A number of years ago, a small group led by Ivan Oransky founded “Retraction Watch”, which tracks retractions as a vital part of the scientific process.