This is a story about a story and a story or two within that story. The first story is one of faulty epidemiology – data collection in a war zone. The first inside one is how medical news and journals affect not only national news, but are being used as political weaponry, to affect elections , and to change history.
Within that story is yet another – how editors contribute to fabrication, accepting or refusing to recognize fraud and misinformation. Yet another is that one cannot change some opinions, even after showing that the original information on which they were based was false. Sound familiar? We’ve been illustrating the point in classes for years.
The Iraq death studies. In 2004, weeks before the US presidential election, the journal, The Lancet published a study from a group at Johns Hopkins University, of Iraqi civilian deaths since the 2003 invasion (Lancet I). The results were unseemly high; a UN group estimated the deaths to be about one tenth of the Lancet’s report. The allied forces were still receiving approval for deposing Saddam Hussein, and the world press did not publicize them.
Then, 2-3 weeks before the 2006 US national congressional elections, with the Iraqi war wearing on and US and the world public tiring of stalemate and casualties, Lancet published a follow-up study (Lancet II) by the same group, concluding that in the years 2003-2006, Iraqi civilian war related deaths exceeded 600,000. It was shocking, made headline newspaper and television news. The study had such a significant impact partly because of where it appeared. The Lancet, despite its spotty record for off-beat articles, is revered by the public and the press. If the article’s publicity did not create a wave of political disapproval, it at least helped whip up the waves of discontent, washing in a major change in the Congress. Criticism of the study at the time seemed drowned out by its publicity. But a recent repeat study of civilian Iraqi deaths brings new light on the Lancet II study.
The press and government agencies ally to shine a disproportionate amount of publicity on false and improbable medical ideas. (Danger: Congressmen and reporters at work.)
The latest was a press release from either the Centers for Disease Control (and prevention? – I’ll get to the “prevention” part later,) or from Kaiser-Permanente Medical Group. Three Bay Area newspapers carried simultaneous articles. The articles announced a new, $338,000 CDC/Permanente study of something they call “Morgellon’s disease.” I say they call it that because what they are describing is not what was originally described as “Morgellon’s,” but what is most likely a form of somatiform illness – delusional parasitosis, or neurodermatitis.
What is Morgellon’s and why is CDC funding Kaiser/Permanente with $338,000 to study it? I was never taught about anything called Morgellon’s, and althoughI had practiced medicine for forty years, I still had not known of it until several years ago when a group of affected San Francisco patients and R L Stricker MD, were reported as having a number of cases of it.
“Who am I? Why am I here?”
Who could forget that memorable quote from Admiral James Stockdale, candidate for Vice President running with Ross Perot in 1992, during the first Vice Presidential debate? In a way, as the seemingly junior member of the crew of bloggers assembled here at Science-Based Medicine, I feel as though I should be asking that question, although I hope that, in the weeks to come, I won’t end up giving the same impression in comparison to the rest of the august crew here as Admiral Stockdale unfortunately did during his debate with, of all people, Dan Quayle. No, I don’t want to be leading readers to wonder just what on earth Steve Novella was thinking when he invited me to blog here as a weekly regular. It doesn’t matter that I’m an NIH-funded surgical researcher who’s also been funded by the Department of Defense and the American Society of Clinical Oncology. All that says is that I’m pretty good at science and cancer research (or, if you’re more cynical, that I’m really good at persuading study sections that I do worthwhile research). Without a track record comparable to that of my co-bloggers writing about the issues that this blog will highlight, you might ask: Why should I be taken seriously?
Science-Based Medicine is a new daily science blog dedicated to promoting the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public. This includes reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.
The philosophy of this blog, at its core, is simple: Safe and effective health care is critical to to everyone’s quality of life; so much so that it is generally considered a basic human right. The best method for determining which interventions and health products are safe and effective is, without question, good science. Therefore it is in everyone’s best interest for health care to be systematically evaluated by the best science available.
Too often the nature of science itself is misunderstood or misrepresented to the public. Science is not an arcane and privileged discipline. By its very nature it is meant to be transparent and public. Science is nothing more than a systematic and careful use of evidence and logic to evaluate factual claims. And good science possesses certain virtues that are not unique to science but generic to all intellectual endeavors: fairly accounting for all available evidence, using valid and internally consistent logic, using unambiguous concepts and language, proper use of statistics, being quantitatively precise and accurate, and above all being honest.