‘The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue’. So wrote Richard Horton, the highly regarded editor of one of the world’s most prestigious medical journals, The Lancet. Having participated in a symposium on the reproducibility and reliability of biomedical research, he and his fellow participants were forced to face up to this unpalatable truth. And yet we have all been schooled to believe that science brings evidence to justify treatment to deliver health. If the first part of this formula is faulty, then what can we really expect of medical science at the sharp end in the consulting room?
Ben Goldacre is the UK’s most high profile critic of poor science. His target more often than not is the pharmaceutical industry. He laments the selectivity of available data on the efficacy of medicines. Nearly a third of this data is unpublished, leading to speculation that it is the contrary results we are missing. Are medicines less effective than we are led to believe?
If we are not in thrall to science these days, it is little wonder. The mantra of ‘evidence-based medicine’ relies on the strength of the evidence. If a substantial portion of the studies are either suspect or missing, we shall struggle to place the findings of science much above the more metaphysical claims of alternative therapies.
One major controversy is with the mass prescription of statins. The evidence appears to be equivocal. Experts continue to argue the merits of the proposed ‘medicalisation’ of generally healthy people over age 50. It is widely suggested that our risks of heart disease would be more effectively reduced by attention to diet and exercise.
Against this backdrop of doubt we nevertheless hold tight to the idea that pills are the front line for our health. We want them to be effective because they demand so little from us; a quick easy fix compared to lifestyle adaptation. And perhaps that is why the public and their doctors allow these systemic fallibilities in medical science to fester.
The promise of scientific method is enormous. But its application should be far more rigorous than it is.