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Book Review: Triumph Of The Heart, The Story Of Statins

Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.

The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.

That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.
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Posted in: Book & movie reviews, Pharmaceuticals

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Research, Minus Science, Equals Gossip

“A person is smart. People are stupid.”

- Agent K (Tommy Lee Jones), Men In Black

Regular readers of my blog know how passionate I am about protecting the public from misleading health information. I have witnessed first-hand many well-meaning attempts to “empower consumers” with Web 2.0 tools. Unfortunately, they were designed without a clear understanding of the scientific method, basic statistics, or in some cases, common sense.

Let me first say that I desperately want my patients to be knowledgeable about their disease or condition. The quality of their self-care depends on that, and I regularly point each of them to trusted sources of health information so that they can be fully informed about all aspects of their health. Informed decisions are founded upon good information. But when the foundation is corrupt – consumer empowerment collapses like a house of cards.

There is growing support in the consumer-driven healthcare movement for a phenomenon known as “the wisdom of crowds.” The idea is that the collective input of a large number of consumers can be a driving force for change – and is a powerful avenue for the advancement of science. It was further suggested (in a recent lecture on Health 2.0), that websites that enable patients to “conduct their own clinical trials” are the bold new frontier of research. This assertion betrays a lack of understanding of basic scientific principles. In healthcare we often say, “the plural of anecdote is not data” and I would translate that to “research minus science equals gossip.” Let me give you some examples of Health 2.0 gone wild:

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Posted in: Public Health, Science and Medicine, Science and the Media

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Where Does Sanjay Gupta Register On The Quackometer?

Four weeks ago I wrote a blog post about Sanjay Gupta’s nomination by the Obama administration as our potential new Surgeon General. Many of you voiced concerns about Sanjay’s nomination, specifically because of his poor handling of the Raelians’ Clonaid fiasco, his inability to counter Michael Moore’s health statistics as presented in Sicko and his relationship to the pharmaceutical industry.

As I wondered about what Sanjay Gupta might be like as Surgeon General – and specifically how he might assist in “restoring science to its rightful place” – I decided to educate myself about his thought processes by purchasing his recent book “Chasing Life.” The question I sought to answer was, “is Sanjay Gupta a crank?”

The short answer is: I’m not sure.  Although I wouldn’t go so far as to say that he is a crank, I think he’s more likely to be a shruggie. For those of you who haven’t read my post on shruggies, here’s the definition:

Shruggie (noun): a person who doesn’t care about the science versus pseudoscience debate. When presented with descriptions of exaggerated or fraudulent health claims or practices, their response is to shrug. Shruggies are fairly inert, they will not argue the merits (or lack thereof) of complementary and alternative medicine (CAM) or pseudoscience in general. They simply aren’t all that interested in the discussion, and are somewhat puzzled by those who are.

The longer answer involves an exploration of Gupta’s disturbing insistence on flirting with cranks, if it gets him publicity. The back cover of Chasing Life caries an endorsement from Deepak Chopra – and the inside page a favorable review from Andrew Weil. Normally, I would assume that the author of any book endorsed by those two would contain an intolerable blend of science and pseudoscience and refuse to read it. But for the sake of the readers of Science Based Medicine, I stifled my gag reflex and purchased the book. I hope that my sacrifice will benefit you all.
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Posted in: Book & movie reviews, Public Health, Science and the Media

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Playing by the Rules

I recently read Flock of Dodos (no relation to the movie of the same name). It’s a hilarious no-holds-barred send-up of the lies and poor reasoning of the intelligent design movement. I was particularly struck by a quotation from William Dembski’s Intelligent Design.

We are dealing here with something more than a straightforward determination of scientific facts or confirmation of scientific theories. Rather we are dealing with competing world-views and incompatible metaphysical systems.

That cuts to the essence of what we are confronting on Science-Based Medicine. We are trying to evaluate the science behind claims that are often not based on science but on beliefs that are incompatible with science. The claimants are happy to use science when it supports them, but when it doesn’t they are likely to unfairly critique the science or even to dismiss the entire scientific enterprise as a “materialistic world view” or “closed-minded.” We are talking at cross purposes. How can we communicate if we say “this variety of apple is red” and they insist “it feels green to me”?

We get frustrated when we show these folks the scientific evidence and they refuse to accept it. Homeopathy is not only implausible, but it has been tested and has failed the tests. Yet proponents refuse to acknowledge those failures and still want to talk about data from the 19th century and make claims for the memory of water. We have to realize we are not even speaking the same language. We are trying to play a civilized game of gin rummy and they are dribbling a basketball all over the card table. Before getting into a debate, doesn’t it make sense to define what game you’re playing and what the rules are?

Science has been a very successful self-correcting group endeavor. It wouldn’t be successful if it didn’t follow a strict set of rules designed to avoid errors. [Note: there are no rules written in stone; I’m talking about conventions that are generally understood and accepted by scientists, conventions that grow naturally out of reason and critical thinking.] If proponents of alternative medicine want to play the science game, they ought to play by the rules. If they won’t play by the rules, they effectively take themselves out of the scientific arena and into the metaphysical arena. In that case, it is useless for us to talk to them about science.
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Posted in: Science and Medicine

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