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Why science in medicine needs all the friends it can get…

The Friends of Science in Medicine is a loose collaboration of doctors and other scientists and concerned citizens who have chosen to speak out on the topic of where science belongs in medicine, and where pseudoscience belongs in society. Much of that discussion has taken place on this very website.

It seems odd that the role of scientific understanding in medicine should even need to be defended, given the extraordinary progress that has been made in the last century with medical technology. The scientific approach to the study of medicine has given more benefit to humanity in the last two centuries than any other form of health knowledge in the last two millenia. Perhaps scientific medicine is a victim of its own success at some level.

Galileo remarked in the 1600s that the goal of science is not to open the door to ultimate wisdom but rather to set limits upon infinite error.There are a million and one ways to be wrong about the human body and the ways that it functions. There are only a few ways to be right. The precise demands of human physiology are remarkably invariable from one human to another, because there are only a handful of ways to defy the improbable odds of being able to maintain existence in this hostile universe. Let alone be self-aware and morally good on top of that! The more detailed the knowledge that science gives us about biology, the more it constrains the possibilities of other proposed states of being in the universe. Homeopathy, Qi life energy, biofield energies, chiropractic subluxations, phrenological bumps and the four humours are just a handful of examples of ways to be wrong about the body that have not been compatible with the rapidly evolving body of scientific biology.

Accumulating facts is not good enough to be scientific, however. As the French mathematician Henri Poincare pointed out

Science is facts; just as houses are made of stones, so is science made of facts; but a pile of stones is not a house and a collection of facts is not necessarily science.

A scientific approach generates facts into hypotheses, which are then tested rigorously and discarded if they fail. A pleasing ideological worldview is no substitute for being able to very closely approximate objective reality. For the science-based health practitioner, a cherished therapy will be ruthlessly jettisoned no matter how painfully if the evidence demands the sacrifice. For most doctors this happens every couple of years throughout their career. I can think of several treatments within my own speciality of Pain Medicine which I have stopped using in the last couple of years, and I expect that in five years I will be treating chronic pain patients differently to the way I do now. I can quote at length the strengths and weaknesses of the evidence supporting all the therapies I currently ask my patients to agree to, and I wouldn’t expect them to settle for less than that. I’m not sure yet which parts of what I currently accept as fairly true will have to be junked in the face of better research, but I can’t wait to find out.

Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable. The science-based health care community has not done very well in the last couple of decades at sharing with the public at large the excitement, frustration and genuine hope of doing real science. We have not explained as well as we perhaps could have why the scientific approach is not perfect, but better than every other system we’ve tried to date. One of the greatest strengths of science is its unselfishness, and its honesty. Self-examination and self-correction is built into the system. We know that the things we have discovered by a disciplined adherence to scientific principles will always be right until something better comes along. The ideas of clinical trials for medications and quarantine for infectious diseases have been around since the great medieval Arab physician Ibn Rushd and are no less correct now than they have always been. In science-based medicine, once you’re right, you stay right. That doesn’t mean we can’t learn something by trying to prove you wrong.

Pseudoscience is fundamentally sterile and unproductive, based more on charismatic personalities, unchanging eternal ‘truths’ and unreliable anecdotes. I have a patient whose back pain was fixed by falling down some stairs while dropping her grand-daughter off at playgroup. That doesn’t mean I have started shoving my other patients down the steps to fix them. It’s just an interesting yarn. DD Palmer started chiropractic based on a similarly improbable cure. Ignaz von Pelczy did the same in starting iridology. No useful research breakthroughs have changed the fate of humanity from either field since.

So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.