Lost Belief In Science or in Scientific Expertise?
It is a time when we should be more scientific, but we seem to have more nonsense than sense both inside and outside of science. National Geographic published "Why Do
Reasonable People Doubt Science." I would indicate that there are
scientific leaders, particularly in health care, that fail to process
scientifically. Science journal also pointed out the many failures in scientific studies with regard to scientific approaches - especially the lack of randomized studies regarding health care delivery.
Reasons for Science Confusion
Those that profit from anti-science - This includes those who profit from controversy and those who profit by paying for their own researchers to "prove" what they want to have proved. Poorly done scientific studies plague both. Major foundations and think tanks often shape support and findings along political or economic lines. Attempts to prove the Triple Aim start and end with this proving focus rather than objective approaches. Tobacco companies delayed the release of numerous studies advancing understanding of addiction - for the obvious reasons that addiction was their intent for as long as possible while enslaving as many as possible. It is not a surprise that the most powerful and the most organized can shape opinions about science. They are shaping voters, Congress, health policy (or lack thereof), and more.
Those that delay science reporting including journals that publish without trials or full data disclosures. The failure of adoption of scientific principles regarding verification is a failure of all in the scientific community.
Science Experts fail - NIH, CDC, Institutes of Medicine, and major journal articles and reports are published despite poor controls and poor assumptions. From To Err is Human to the insurance access studies to studies of rural hospitals to studies of different types of clinicians (NP vs MD) to the present ACE studies (adverse childhood experiences), the studies are begun and are funded and are conducted and are analyzed and are reported to fit with a preconceived notion. And much of the data that would indicate other reasons related to the patient or to their situation is not present in the analysis (not collected, not though of, not included).
Science Experts Fail Because of what they have failed to experience within their own lives or the lives or those around them since birth - people quite different from normal Americans. There has been a failure to understand that outcomes are more about the entire life experience of the patient. This is also why the highly promoted disruptions and innovations and reorganizations fail to work as they fail in scientific areas. Fixing doctor errors, decisions based on big data, digitization focus, or improvements of insurance access are assumed, often incorrectly, that these will fix health care woes. We now know that we do not have the massive improvements in lives saved. Such studies were widely spread as the saviors of health care - and their failure darkens belief in interventions, health reform, and science itself.
Reversals of recommendations - Numerous reversals occur when studies are done rather than assumptions promoted - regarding infant sleeping position, immunizations, dietary supplements...
Failure to Integrate
We have numerous failures to integrate, but the area of science needs most to have an integration into societal usefulness at the local level. We fail to integrate public health and basic health services information with basic education and local health needs.
What is good for the Health of the People fails to get to the people when the opportunity is best. Best for applying science to health is when students become more social and desire interactivity and seek meaning for life. Applied health and applied science can be integrated with local middle school and high school in ways that improve local health care.
A focus on a few advancing to college and further is not going to help more than the few. Few advancing to lead in science, may also be a reason why the needs of most Americans in health care are not better understood.
The CDC For Better or for Worse
Somehow the CDC has managed to fly beneath the radar, but this is not likely to last. Lab failures regarding anthrax and avian flu, antiviral recommendations that may favor drug companies too much (flu, Hep C, AIDS), and a widening focus beyond infectious disease control may impair efforts regarding ebola, measles, and communicable diseases.
Some antiviral experts have begun to heat up critique regarding the CDC and antivirals such as Tamiflu. 5 years of delay in reporting allowed Tamiflu to gain widespread use and high public expectation. Tamiflu helps at best for 1 less day of symptoms. Those at risk for adverse outcomes have not been demonstrated to be protected. The FDA and the CDC disagree and science is not served. The cost of Tamiflu is high for the benefit, and the GI and other side effects can be serious - especially in children.
The focus on Hepatitis C screening seems more like a bait and switch - benefiting the anti-viral manufacturers. The positive screening decisions to screen were based on studies involving older drugs lower in cost and known to be less and less effective - not the far more costly drugs known to be coming.
The CT screening for lung cancer studies also stretched science by failing to include all of the important costs or consequences or costs of the consequences. The failure is also in practicality. It is well known that such recommendations are abused. Overuse of CT scanning outside of the guidelines to those less at risk was already a reality before the studies and long after.
The failures of the scientific process to protect human subjects in do no harm, beneficent intent, informed consent, and protection of vulnerable populations have been addressed over the past 50 years from Nuremberg to the present. It may yet be 50 years before Pay for Performance, readmission penalties, and value based payments are seen to violate these important principles. Indeed they are known to have adverse impacts upon the most needed health providers and indirectly upon the populations that they serve.
Today I was made aware of the CDC support of the ACE studies - Adverse Childhood Experiences. The CDC like others is trying to make headway in understanding obesity and other conditions, but has a hard time linking to anything but disease. The associations are not "clean" because many, many different factors have the same associations and any one of these could appear to be "the reason" when other variables are not included. These are not causation studies because it takes entirely different scientific approaches.
The same associations with poor outcomes are seen in the poor or those who provide care for them in rural or in small practices - and across social determinants and other facts of life and living - especially for those normal to disadvantaged as compared to those advantaged (Small Health Care).
ACE focus or ACE intervention, in my opinion, is not likely to result in prevention of ACEs or early intervention. The ACE screening is far too late. Studies done by students on populations with high ACE incidence have revealed low interest in pursuing ACE. The ACE failure is one result of doing ACE studies on Kaiser populations rather than normal to disadvantaged populations. For a best societal outcome, it would be better to focus on better support of young parents and their children in the earliest months and years of life.
Until there are improvements in areas such as child well being and social determinants, I doubt that the nation will have any improvement in health, education or the general welfare of the people.
Non-communicable disease focus is a fit with science, if it were not turned into more benefits for drug companies using studies that can show minimal benefit for the cost involved.
Science can guide our nation well, but it needs to be guided more specifically by science.
The CDC Conflicting (Conflicted?) Info, Tamiflu and unquestioned news reporting
Real Reasons for Rotten Outcomes
Reasons for Science Confusion
Those that profit from anti-science - This includes those who profit from controversy and those who profit by paying for their own researchers to "prove" what they want to have proved. Poorly done scientific studies plague both. Major foundations and think tanks often shape support and findings along political or economic lines. Attempts to prove the Triple Aim start and end with this proving focus rather than objective approaches. Tobacco companies delayed the release of numerous studies advancing understanding of addiction - for the obvious reasons that addiction was their intent for as long as possible while enslaving as many as possible. It is not a surprise that the most powerful and the most organized can shape opinions about science. They are shaping voters, Congress, health policy (or lack thereof), and more.
Those that delay science reporting including journals that publish without trials or full data disclosures. The failure of adoption of scientific principles regarding verification is a failure of all in the scientific community.
Science Experts fail - NIH, CDC, Institutes of Medicine, and major journal articles and reports are published despite poor controls and poor assumptions. From To Err is Human to the insurance access studies to studies of rural hospitals to studies of different types of clinicians (NP vs MD) to the present ACE studies (adverse childhood experiences), the studies are begun and are funded and are conducted and are analyzed and are reported to fit with a preconceived notion. And much of the data that would indicate other reasons related to the patient or to their situation is not present in the analysis (not collected, not though of, not included).
Science Experts Fail Because of what they have failed to experience within their own lives or the lives or those around them since birth - people quite different from normal Americans. There has been a failure to understand that outcomes are more about the entire life experience of the patient. This is also why the highly promoted disruptions and innovations and reorganizations fail to work as they fail in scientific areas. Fixing doctor errors, decisions based on big data, digitization focus, or improvements of insurance access are assumed, often incorrectly, that these will fix health care woes. We now know that we do not have the massive improvements in lives saved. Such studies were widely spread as the saviors of health care - and their failure darkens belief in interventions, health reform, and science itself.
Reversals of recommendations - Numerous reversals occur when studies are done rather than assumptions promoted - regarding infant sleeping position, immunizations, dietary supplements...
Failure to Integrate
We have numerous failures to integrate, but the area of science needs most to have an integration into societal usefulness at the local level. We fail to integrate public health and basic health services information with basic education and local health needs.
What is good for the Health of the People fails to get to the people when the opportunity is best. Best for applying science to health is when students become more social and desire interactivity and seek meaning for life. Applied health and applied science can be integrated with local middle school and high school in ways that improve local health care.
A focus on a few advancing to college and further is not going to help more than the few. Few advancing to lead in science, may also be a reason why the needs of most Americans in health care are not better understood.
The CDC For Better or for Worse
Somehow the CDC has managed to fly beneath the radar, but this is not likely to last. Lab failures regarding anthrax and avian flu, antiviral recommendations that may favor drug companies too much (flu, Hep C, AIDS), and a widening focus beyond infectious disease control may impair efforts regarding ebola, measles, and communicable diseases.
Some antiviral experts have begun to heat up critique regarding the CDC and antivirals such as Tamiflu. 5 years of delay in reporting allowed Tamiflu to gain widespread use and high public expectation. Tamiflu helps at best for 1 less day of symptoms. Those at risk for adverse outcomes have not been demonstrated to be protected. The FDA and the CDC disagree and science is not served. The cost of Tamiflu is high for the benefit, and the GI and other side effects can be serious - especially in children.
The focus on Hepatitis C screening seems more like a bait and switch - benefiting the anti-viral manufacturers. The positive screening decisions to screen were based on studies involving older drugs lower in cost and known to be less and less effective - not the far more costly drugs known to be coming.
The CT screening for lung cancer studies also stretched science by failing to include all of the important costs or consequences or costs of the consequences. The failure is also in practicality. It is well known that such recommendations are abused. Overuse of CT scanning outside of the guidelines to those less at risk was already a reality before the studies and long after.
The failures of the scientific process to protect human subjects in do no harm, beneficent intent, informed consent, and protection of vulnerable populations have been addressed over the past 50 years from Nuremberg to the present. It may yet be 50 years before Pay for Performance, readmission penalties, and value based payments are seen to violate these important principles. Indeed they are known to have adverse impacts upon the most needed health providers and indirectly upon the populations that they serve.
Today I was made aware of the CDC support of the ACE studies - Adverse Childhood Experiences. The CDC like others is trying to make headway in understanding obesity and other conditions, but has a hard time linking to anything but disease. The associations are not "clean" because many, many different factors have the same associations and any one of these could appear to be "the reason" when other variables are not included. These are not causation studies because it takes entirely different scientific approaches.
The same associations with poor outcomes are seen in the poor or those who provide care for them in rural or in small practices - and across social determinants and other facts of life and living - especially for those normal to disadvantaged as compared to those advantaged (Small Health Care).
ACE focus or ACE intervention, in my opinion, is not likely to result in prevention of ACEs or early intervention. The ACE screening is far too late. Studies done by students on populations with high ACE incidence have revealed low interest in pursuing ACE. The ACE failure is one result of doing ACE studies on Kaiser populations rather than normal to disadvantaged populations. For a best societal outcome, it would be better to focus on better support of young parents and their children in the earliest months and years of life.
Until there are improvements in areas such as child well being and social determinants, I doubt that the nation will have any improvement in health, education or the general welfare of the people.
Non-communicable disease focus is a fit with science, if it were not turned into more benefits for drug companies using studies that can show minimal benefit for the cost involved.
Science can guide our nation well, but it needs to be guided more specifically by science.
The CDC Conflicting (Conflicted?) Info, Tamiflu and unquestioned news reporting
Open Season Upon Small Health Care
Understanding Common Errors in Quality StudiesReal Reasons for Rotten Outcomes
Rotten Apples, Rotten Support, or Rotten Media?
Improving Health Care is Not Likely for 2600 CountiesGlobal Fails Local But Local Focus Succeeds Globally
Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...
Blogs indicate that primary care can be recovered and should be recovered.
Robert C. Bowman, M.D. Robert.Bowman@DignityHealth.org
Dr.
Bowman is the North American Co-Editor of Rural and Remote Health. He
was the founding chair of the Rural Medical Educators Group of the
National Rural Health Association and the long term chair of the STFM
Group on Rural Health.
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