Trust in science and medical experts

This week is a good time to talk about trust in expert opinion and science.

For the past forty years, nutrition experts in the US have warned us about cholesterol and fat. Eat too much of it and it will block your arteries, was the proclamation. Americans did what the scientists and experts said. They ate low-fat foods. You see how that worked out.

Now, the Dietary Guidelines Advisory Committee will soon tell the American people that they were wrong about saturated fat and cholesterol. Experts, who had based their recommendations on scientific evidence, will reverse course and say…oops. Our bad. The science was not that good, and, it turns out, human biology and atherosclerosis is more complicated than we thought. Eat your eggs.

More important here is not that science was wrong and that old discoveries were overturned by new evidence. That is normal. What bothers me is something Dr.David Allison, a public health professor at the University of Alabama at Birmingham, rightly said in the Washington Post piece.

… the problem in nutrition stems from the arrogance that sometimes accompanies dietary advice. A little humility could go a long way.

“Where nutrition has some trouble,” he said, “is all the confidence and vitriol and moralism that goes along with our recommendations.”

Confidence, vitriol and moralism are not just a part of nutrition advice. These human characteristics infect lots of other expert scientific recommendations. Ad hominem attacks followed my Growing Doubt on Statins post in which I questioned the value of statins for the primary prevention of heart disease. I was doing harm by doubting the benefits of a drug.

Maybe it is just me, but I sense a growing intolerance of dissent in medical science.

One problem with prevailing wisdom in medical science is that it gets into guideline statements. And in doing so, experts codify quality medical care. Here is a result: last week, an elderly patient was discharged with the diagnosis of congestive heart failure. His nurse collated 30-pages of discharge instructions on his 5 new medications–which were proven effective in clinical trials.

On those clinical trials–and proof: A piece of science news worth looking at is this week is a report from investigative journalist Charles Seife. He and his team of students found that not only was there evidence of scientific misconduct in clinical trials, the FDA knew about it, and did not notify the public or the medical establishment.

JAMA-IM bravely published these findings. Hardly a peep was heard on social media. Worse: Some of the “superior” drugs mentioned in the article sit as samples in my office, and their makers feed our office staff, and advertise on the evening news. The Brian Williams scandal pales in comparison to the scourge of direct-to-consumer big-Pharma ads.

(Staci, who is now on Twitter as @DrStaciM, and should be followed, reminded me to mention Multaq. Oh, and LifeVests, too.)

I have more. If you are reading this on a treadmill, get off and sit down: Cochrane Collaboration researchers discovered in 2012 that industry-sponsored clinical trials produced favorable results more often than independent studies. A shocker indeed.

And those are the published trials. Most trials do not get published, and non-publication is not random. This group of researchers found that negative trials are less likely to be published. Another surprise.

So, in honor of the cholesterol reversal and our reverence to all things scientific and expert, I will conclude with a link to my most important blog entry. Changing the culture of American Medicine — Start by removing hubris.

JMM