Debate in science is essential. You would hope it were the very lifeblood of progress. One would also hope that researchers could disagree with each other in frank and open debate. But it has become increasingly obvious to me that if you criticise the experts in medical research you can expect a very rough ride indeed. You certainly risk being stomped into silence.
I have witnessed this quite a lot recently, and have found that the ‘stomping’ game is very simple. If a critic of an area of mainstream medicine seems to be gaining some traction with the public, they are very rapidly accused of ‘killing patients’ by various professors a.k.a. ‘experts.’
Sadly, it has become an article of faith that ‘experts’ cannot be argued with. For they have attained the status of demi-gods. Recently, I was reading an article about Daniel Kahneman, Nobel Prize winner in economics. He was discussing the irrationality of the financial system. He made many interesting points. For example:
‘The way scientists try to convince people is hopeless because they present evidence, figures, tables, arguments, and so on. But that’s not how to convince people. People aren’t convinced by arguments, they don’t believe conclusions because they believe in the arguments that they read in favour of them. They’re convinced because they read or hear the conclusions from people they trust. You trust someone and you believe what they say. That’s how ideas are communicated. The arguments come later.’
Slightly later on, he talks about his own belief in global warming:
‘Why do I believe global warming is happening? The answer isn’t that I have gone through all the arguments and analysed the evidence – because I haven’t. I believe the experts from the National Academy of Sciences. We all have to rely on experts.’
We all have to rely on experts? So says Daniel Kahneman. A man whom I generally greatly admire. In this case though, I could not disagree more violently. In one breath he states that people aren’t convinced by arguments; they’re convinced because they read or hear conclusions from people they trust. Then he says that we all have to rely on experts. But he does not link these two thoughts together to ask the obvious question. Just how, exactly, did the experts come to their conclusions?
By listening to people they trust? And who might they be? Other experts presumably. And how did they come to their conclusions….by listening to other experts. And how did they come to their conclusions. Hold on, it seems we are trapped in a loop of self-reinforcing logic. There is no escape.
In this area, I tend more to go along with Professor David Sackett:
‘According to the founder of Evidence Based Medicine experts are hindering the healthy advancement of science.
Writing in this week’s British Medical Journal (BMJ), Canadian-based researcher, David Sackett, said that he would “never again lecture, write, or referee anything to do with evidence based clinical practice”. Sackett is not doing this because he has ceased to believe in evidence based clinical practice but, as the BMJ comments, because he is worried about the power of experts in stifling new ideas and wants the retirement of experts to be made compulsory.
Sackett claims that the prestige of experts (including himself) gives their opinions far greater persuasive power than they deserve on scientific grounds alone.”Whether through deference, fear, or respect, others tend not to challenge them, and progress towards the truth is impaired in the presence of an expert,” he writes.
He also argues that expert bias against new ideas operates during the review of grant applications and manuscripts. “Reviewers face the unavoidable temptation to accept or reject new evidence and ideas, not on the basis of scientific merit, but on the extent to which they agree or disagree with the public positions taken by experts on these matters.” 1
My rather cynical view is that experts can be compared to those men (usually men) who have grabbed hold of the microphone at the front of a mob during a protest march. With this simple act they have managed to gain status and authority. Shortly after they become spokesmen for the revolutionary movement, then leaders…then despots.
However, most newspapers, journalists, television producers never ask they question, how did an expert become an expert – what makes them so. Instead, they are completely in the thrall of the ‘expert, and greatly fear their power. Which means that when an eminent professor loads and fires the ‘you’re killing patients’ gun, all hell breaks loose and panic stalks the land. Journalists, newspaper editors, TV producers and suchlike quiver in fear. They instantly retract everything they have ever published on the matter, and promise never to do it again.
The example of Andrew Wakefield is familiar to all. He stands accused of causing the deaths of thousands of children. Fewer people have probably heard to Peter Gotzsche, who is a professor and head of the Nordic Cochrane Collaboration (yet, not an expert). He has long been a critic of a breast cancer screening. Which has not endeared him to many who work in that field. He is regularly accused of killing thousands of women.
He was forwarded a copy on e-mail by a colleague. It has been written to one of his greatest critics Lazlo Tabar by another ‘expert’. It contained this section – which I have reproduced in full from Professor Gotzsche’s book ‘Mammography screening, truth lies and controversy’
‘What is remarkable to me is that this man (i.e. Dr G) calls himself a scientist since he obviously and knowingly ignores the scientific method in order to further his own agenda, whatever that may be. I cannot believe he is so intellectually deficient that he cannot grasp the plethora of evidence that so strongly supports the benefits of screening. What then drives him so blindly in his crusade to convince us that all the world is flat? To become infamous as a contrarian, standing lonely on the curvature of the as he denies is spinning under his feet? Or is it something even more petty? An all-consuming hatred and jealousy of Lazlo Taber, whose impeccable trial facilitated by meticulous Swedish record keeping and a socialist society provides a setting unparalleled in the world for a scientific trial? What is tragic and make G’s ravings sinister is that I am sure his influence has resulted in women’s unnecessary deaths somewhere in the world. The Scandinavians are known for their fair-minded, progressive concern for women, as well as for their intellectual integrity. IN this regard, PG is certainly a Nordic contrarian.’ [G or PG in this case refers to Peter Gotzsche]
Well, that’s very pleasant. However the part that I wish to draw attention to is this short section…’I am sure his influence has resulted in women’s unnecessary deaths somewhere in the world.’ A difficult statement to either prove, or disprove – I would think. However, the weapon is familiar ‘You are killing patients.’
On pretty much the same lines, I reproduce two short sections from a letter written to Dr Uffe Ravnskov by Professor John Kastelein (A big noise in CV research). He is objecting to Ravnskov’s view that raised cholesterol does not cause heart disease:
‘If this was a joke, I could have laughed about your statements heartily, but they are in fact criminal and bordering on the insane….. I insist that you refrain from any advice to any patient anymore. You are lucky not to live in the Netherlands. I would have dragged you to court.’
Once again, a nice polite scientific debate. Accusing someone of being criminal bordering on the insane. More recently, you will have noted the successful attempt to crush the Australian Catalyst programmes. One of which criticised the diet heart/cholesterol hypothesis. The second program was critical of the ever increasing prescribing of statins. I mentioned it in my last blog
The controversial Catalyst program on statins and heart disease, The Heart of the Matter, was attacked by health experts even before it aired last year.
The presenter of ABC radio’s Health Report, Norman Swan, warned “people will die” as a result of the TV program’s messages about heart medications.
Swan, whose criticism of the program has been vindicated by the independent Audience and Consumer Affairs Unit report, had said the program made him “really angry” because it might affect Indigenous Australians, who are especially likely to suffer from high cholesterol.’
Once again the ‘you’re killing patients’ gun was prepped and fired to pretty devastating effect. Both programmes were pulled from the air with humble apologies all round. Even the first episode ‘dietary villains’ was pulled,which was found to contain no errors at all. Guilt by association I suppose.
A similar battle is being fought in the UK between the statin experts, and those who would criticize them. It has been going on for some time. In 2011 the Cochrane Collaboration published a report very critical of the benefit of statins in low risk/primary prevention patients.
Professor Sir Rory Collins, the most eminent statin expert took great affront, and started to pick the paper apart, claiming it was highly dangerous and damaging. At one point claiming it was far more dangerous than Andrew Wakefield’s Lancet paper.
I quote from 2011:
‘In public health terms it is potentially a far more serious misinterpretation than that of Wakefield and the MMR in the Lancet.’2
He doesn’t state that the Cochrane collaboration is killing patients directly, but by using the example of Wakefield, we know exactly what he means. ‘You are killing patients.’
Professor Collins has warmed to this theme more recently. As you may be aware he has been attacking the BMJ recently for publishing articles about statins which claim that they have significant side-effects. He vehemently protests that they have virtually none. I quote him again, this time from the Guardian:
“It is a serious disservice to British and international medicine,” Collins told the Guardian at the time, claiming that the alarm caused was probably killing more people than had been harmed as a result of the paper on the MMR vaccine by Andrew Wakefield. “I would think the papers on statins are far worse in terms of the harm they have done.”3
He has been recently followed on this theme by Professor Magdi Yacoub (A famous heart surgeon, now retired from this job). Who is pressing the ‘you’re killing patients’ button with great enthusiasm.
Hey guys, engage in scientific debate, or shut up. Accusing people of killing patients is a terrible and horrible insult, and should play no part in any discussions of this sort. It is the tactics of the playground bully. Yes, I mean you.
References (may require site registration or membership to access)