What is Science Willing to Do for Truth?
Physics is light years ahead of Medicine
Recently, I was having lunch with a colleague in St. Louis, where I gave 4 talks (coming soon to Youtube). In addition to an MD, he has a PhD in Physics. He told me the story of the detection of gravitational waves. These waves were predicted over 100 years ago, but required extreme efforts to measure.
To measure gravitational waves, two sets of planed mirrors were placed miles apart and a laser was shined between them. The waves would manifest as a movement of the laser. This movement would be miniscule and have to be measured apart from the movement of a million other things, including the earth’s crust and traffic.
On September 14, 2015, gravitational waves were detected from a merger of two black holes. This was the end result of hundreds of years of engineering, mathematics, and human will.
I apologize to anyone who feels my description is inaccurate. I am not a physicist, but I am an expert in evidence based medicine and the lesson I see is inescapable.
In physics, the entire research community is committed to working to develop better methods to measure and understand the universe. They will spend 100 years to measure gravitational waves.
In medicine, many doctors, perhaps the majority, constantly ask us to remain ignorant. They make up stories and distortions as to why we cannot study things better.
Cloth masks are a parachute and we can’t run randomized trials to assess if they work
We can’t test the fall booster with randomized trials because the results would take too long to generate
It would be unethical to run a randomized trial of mammography in 2023 because that means half the women don’t get mammograms
And on and on.
In every one of these cases, doctors who oppose generating better knowledge estimates are incorrect. They are incorrect because they are ignorant of the history of medicine, and the frequency with which our practices have been wrong.
They are also prone to be incorrect because the financial apparatus of medicine does not reward knowledge generation— if anything this threatens the livelihood of countless practitioners.
Unlike physics, we don’t have a commitment to generate better data. That is medicine’s greatest weakness, and sadly our patients pay for it.
Having practiced oncology for 30 years, the main difference I have observed with younger generations is their transactional approach to care. Every day practice is nothing but the implementation of guidelines generated by doctors with conflicts of interest. Worse yet, so called academic institutions carry out research intended to approve new drugs with little data. Trials are designed to show the minimal statistical proof that leads to FDA approval , often with little benefit to patients. We used to have journal clubs where we dissected published data and gained knowledge from imperfect and flawed studies. This exercise in critical thinking has vanished.
“it is difficult to get a man to understand something, when his salary depends on his not understanding it.” - Upton Sinclair.