Science and Modernity. Single, double and triple blind trials and why they matter.
Anthony Bishop lives in Murarrie with his wife and children. He grew up in the Southside suburb of Rochedale and attended QUT, graduating in 1988 with a degree in Medical Laboratory Science. This set him on a career path in pharmaceutical research, where he has gained experience as a scientist, project manager and sales in large Australian and international companies and a project director and CEO of small pharma and diagnostic research start-ups in Brisbane, Melbourne, Singapore and Malaysia. He has recently been appointed as the Liberal candidate for the electorate of Griffith. Anthony is also a great supporter of Tuesday Dialogues and we would like to thank him for opening our eyes, and possibly causing concern over the use of scientific information in politics.
Overview
The discussion ranged widely over the use and abuse of scientific information in politics, the interpretation of scientific results, the impact of widely held scientific beliefs on policy, the influence of pressure groups in using scientific results to further their own agendas, together with the responsibility of politicians and those who have performed the experiments to ensure the results of this scientific research are correctly represented.
Key Points Made
The scientific method relies on people observing things, making a hypothesis as a result of that observation, carrying out experiments to test that hypothesis and obtaining a result from the experiments.
An experiment: To illustrate how bad science can inform policy a simple experiment was conducted to test the hypothesis that colours make people happy. Four subjects were asked to taste/eat a lolly and to indicate on a scale how happy they were before and after eating the lolly. It was a blind trial in the sense that the subjects did not know the colour of the lolly they were eating. The results showed that those who ate the coloured lolly were happier after eating. Of course there are many problems with this experimental design but the point was made that these results would be taken at face value to prove the claim that colours make people happy. The results would no doubt be published. Statistical analysis would be performed. Journalists would put their own slant on the results. Public policy on the use of colour would be developed using these results. Future research would take these results as a primary basis for their further analysis. All of this based on an experiment with a flawed design.
Three initial points were raised as being important when considering science and policy.
The first point considered was the deficit model of increasing scientific knowledge. This is characterised by designing and performing experiments to rectify our deficit in knowledge of a particular topic. This is the data model. The supporters of this idea think that the reason you don’t agree with me is because you do not understand something.
The second point considered was the scientific knowledge held by epistemic communities, that is, a community with recognised expertise and authoritative claims to policy relevant knowledge in a particular area. These epistemic communities have shared knowledge, expertise, and belief or a way of looking at the world. Politics forms an epistemic community based around a party or a policy preference of a way of thinking about things. Why hasn’t worldwide consensus quashed climate change denial in the US – a study at the Harvard Kennedy School provided the answer – it’s politics stupid. Example was also given of the discovery by Dr Barry Marshall, an Australian who ultimately won the Nobel Prize for research which determined that it was Helicobacter Pylori which caused stomach ulcers rather than the long held view that it was stress, with the result that treatment with antibiotics provided a better outcome. He was pilloried for years for having this “stupid idea”, the academic community, which believed it was complete nonsense, was firmly against him. Then finally Dr Marshall’s research became the belief of the epistemic community so when at a meeting in Sweden a young scientist presented what appeared to be cogent results of the beneficial effects of yoghurt on stomach ulcers in contrast to the value of antibiotics, the epistemic community was completely against him in a very ugly way. An epistemic community is very protective and hold onto their ideas vigorously.
A third point considered was that there is a distinction between a transcendental question and a scientific question. A transcendental question is linked to religion literature and metaphysics and a scientific question is linked to the organisation or structure of the material universe. A Nobel prize winner Peter Medewar has written in this area - what science can or can’t tell us and how true is the knowledge that we obtain through religion, literature or metaphysics.
Scientific results can be interpreted in particular ways to drive political opinion.
In a discussion about science and politics, are we talking about the dearth in somebody’s knowledge influencing policy or are we talking about power. Are epistemic communities really just about power. We need to consider what the message is from any scientific experiments that are undertaken. Everybody reading the results of a scientific experiment will see something that fits part of their epistemic community and will be empowered by it. We need more carefully to consider what the actual message is from any scientific experiments that are undertaken.
Covid: In the development of a vaccine for covid, the study by the pharmaceutical companies was designed to determine whether or not the proposed vaccine would keep people out of hospital. However politicians took the results and encouraged people to become vaccinated by saying that “grandma would die” if people did not become generally vaccinated. A lot of people made the assumption from what was said that the vaccine would stop transmission. There was much argument by analogy with the flu vaccine. Companies did not however make this claim. Their studies were designed simply to determine whether the vaccines would keep people out of hospital. The question was raised as to whether it was the responsibility of the pharmaceutical companies to correct this misunderstanding.
Gender intervention:
Reference was made to a contributor from the table, a psychiatrist who had been stood down from a hospital for questioning the official view concerning the appropriateness of gender intervention for biologically normal children. An expert view from the psychiatrist stated that the majority of young people grow out of gender distress by adolescence. However the government had set up a gender clinic in 2017 and was committed to the view that puberty blockers could be used to help transgender children. Pressure was put on parents to go along with it. In Australia every State was compelled to follow the same model when considering gender intervention. There was no room for individual judgment. There is no other mental intervention in Australia that suffers the same restrictions. There is also no other sort of diseases in which you get so many workplace flags, ie, there is a lot of transgender pride information all over the hospital as well as changes in language, in the definitions being used for transgender people. The change in language is put at the start of every education program or journal article, telling you exactly what transgender means or binary means. The UK, America and Europe are winding back gender intervention. Although the CASS report from the UK questioned the appropriateness of gender intervention the Australian government was committed to the treatment. They were holding to it like a religious belief.
This is a political movement not a health treatment. Did the wish for gender change only come as a result of puberty blockers becoming available. (Note gender affirming is dealing with biologically normal children, it is not dealing with intersex children who are a completely different case.)
Why did this become such a Western world wide priority? The suggestion was made that these views appeal to people who want to change society totally, ie get rid of the biological family. It seems to align with the left wing values of being progressive, human rights and abandonment of Christianity. It seems to appeal to people who want to change society, diversify society and have it non-traditional. Some people even say get rid of male, female, and the biological family. We are all just individuals. It was a strong political movement put forward as a human right for transgender people.
The question was raised of the benefit of having standards vs being able to exercise own judgement. There is value in establishing a standard but a tension between this and being able to question. Freedom to treat patients according to a doctor’s own experience conflicts with the idea that you should be able to obtain the same treatment from a doctor/hospital wherever in the country you go. This is why the abortion rights issue in the US is regarded as so important. Once one state confirms the right to an abortion should it not be available in all States. Can understand why a law would be put in place as to treatment but there should be wider discussion about establishing any such standard.
Reference was made to the use of psychiatry as a means of control and Russia was given as an example. Russia did not want to appear authoritarian so when people opposed the regime, they were classed as crazy, and diagnosed as being schizophrenic. This also happened in Romania.
Medicine needs to be guided by ethics. In medicine we will get to the stage where we can do radical things, eg transplant a uterus into a man. How much of this is a scientific question and how much is ethics. Is it ever ethical to sterilize a child? Is this transcendental knowledge rather than scientific knowledge?
Another thing to consider is, politicians have to look at the scientific evidence and they also have to get votes. This is the lens through which they look at scientific evidence and they create public policy using this lens. Eg It was suggested that Trump may use scientific evidence to promote his anti-DEI agenda. The point was also made that if, for example, you wish to study butterflies in Bolivia you would have a much greater chance of getting funding if you frame it as wanting to study the effect of climate change on butterflies than if it were framed in any other way.
The conceived wisdom is that politicians think that they need to be seen to be firm in their conviction. One of the reasons politicians are strong in their claims is that 30-40% of voters are soft voters, they change their view. But there are problems with “the short grab”. If politicians talked more fully than just through sound bites, voters would have a better idea of what was happening. There are different types of campaign, one where you meet people so they can see you are a good person, here you can say more, but if it is a media run campaign you need to use sound bites.
Science does drive a lot of policy, for example the PBS (Pharmaceutical Benefits Scheme) relies on evidence from clinical trials to approve new drugs. However it also looks at costs and impact from other policy. It was put forward that the Quality Adjusted Life Year is relevant, if using a drug can provide a Quality Adjusted Life Year for $100,000 then the drug would be approved ie a cost/benefit analysis is applied. This works quite well until politicians want something. Furth,er pressure groups, (Breast cancer pressure group was given as an example) if they are sufficiently strong or emotive could get what they want even if it does not pass the Quality Adjusted Life Year test.
What are facts and what are opinions?
A lot of science is less rigorous than you think. Consider our own experiment which would be written up with the hypothesis, supporting the results with statistical criteria.
Trump is currently putting 20% of the science budget towards repeating experiments to make sure that they are repeatable. His argument is that many scientific studies cannot be reproduced. The point was made that this replication program is not new having been run by one organisation since 2007. Economics and social sciences have been hardest hit by this requirement for replication.
There is a study which has shown that 47% of US citizens can’t distinguish between an opinion or a fact. And in Australia it was suggested numbers would be similar. For example in the media literacy space we know that 97% of Australians struggled to tell misinformation online from true information.
Many opinions are generated from the heart! It is your heart and your emotions which are more powerful than necessarily knowledge. People’s desires very much influence the way the process information – the desirability bias - ie if you want something to be true you believe it to be true, it is a very strong and replicable effect.
The other issue is confirmation bias, where our expectations bias our information processing. There is research that suggest that this is actually based on the desirability bias. So our expectations are in some sense determined by our desires, we see the world as we want to see it and getting around this is part of good science.
There is a problem when we cannot talk to one another because we have different world views which impact on our understanding of the same problem. If you grow up in one community you use your own language to explain a particular problem. So any dialogue between two communities could be at cross purposes as the communities don’t share language or interpret the issue in the same way. So the question is how are we actually able to share information in a way that enables us to have a constructive conversation. Mention was made of the fact that people get benefit from being in a community. For example if a Seventh Day Adventist stopped believing it is quite possible they would not admit it to their friends as it is not completely their belief that is important to them it is being in the community, their shared general values. The shared memories and connections of a community are important. We need to be lot more humble when looking at our beliefs because we cannot know everything. But how do we get decisions made on a scientific basis when we are prepared to bury our beliefs to be part of a community.
Is a lie told in the pursuit of a better outcome really a lie. Eg politicians took their primary school knowledge of what a vaccine does to allow them to say you must be vaccinated. In covid some chief health officers did stretch the truth. We need to say exactly what the situation is and admit what we don’t know. The question was raised again what responsibility did the pharmaceutical companies have to make it clear that nothing had been proven with regard to transmission. In covid, debate degenerated into slogans. You need information from people who have reputations for being reasonable. Society is starting to not be able to discuss anymore. We throw stones and yell at one another. It was suggested that when the politicians started to say we could not go to the beach or to the parks that it became clear something was wrong. This illustrates that good intentions are not enough. Truth has value, particularly as trust is important.
Are politicians just giving us candy, keeping us happy, we don’t really want to hear the truth, eg do we really want to know what the rate of inflation is?
Journalists pick up scientific results and take what they need from them to sell newspapers. Is this fact or opinion?
Other
The point was made that politicians do not like blue sky research but the history of technology says that blue sky research has led to big changes.
Received opinion is frowned upon, data is needed. One of the great driving forces of science is to knock off a well held belief.
The question was raised, do we start with a premise and then look for data to support it?
We need to be sceptical and the question was raised have we become worse at this. We need to remember where we are wrong. We need better thinking and more understanding.
The answer to bad things and bad science is good science. The CASS report was good science, it looked at all of the studies that said there is no evidence. So gender intervention was all about politics.
When you talk about the deficit model the position is - I don’t know something - I set out to solve the question and -obtain the answer. Now I know it but you don’t. So obviously the deficit now lies in you. How do you escape that? Scientists have explicit knowledge that other people don’t have. How do you fill this deficit?
There are also people who do not care so the issue does not grow and there is nothing you can do to make them care.
Scientifically educated politicians may be a good thing. It would be preferable for an education minister to be a teacher and health minister should be a doctor etc as they would then understand “on the ground” issues. Most people in politics are career politicians and don’t understand “on the ground” problems. It is one of the few jobs in society where there is no qualification, examination or in fact anything that is required to be able to hold the position.
To change things perhaps we should have longer terms, or perhaps we should say that you cannot run for parliament twice? Should we keep compulsory voting? The suggestion was that we should keep compulsory voting as it is important that everyone is taken into account. Talking to voters, most don’t have a good framework for why they think what they think. For example, they like a rebate for electricity but don’t have a model for how that actually works. This influences how politicians are able to communicate.
In science, high school interns at Clive Berghofer are doing things that would be regarded as science fiction by older scientists.
Thatcher – “Advisers advise, Ministers decide”.
Still, it was suggested, have faith in bureaucracy. We must have faith in bureaucracy.