As we know,
There are known knowns.
There are things we know we know.
We also know
There are known unknowns.
That is to say
We know there are some things
We do not know.
But there are also unknown unknowns,
The ones we don’t know
We don’t know.
—Donald Rumsfeld, Feb. 12, 2002, Department of Defense news briefing
I must have read thousands of scientific research articles throughout medical school and residency. Back then I was a sponge for this new kind of information. When I began medical school in 1998 we learned that most all of menopausal and post-menopausal women should be taking hormone replacement therapy to reduce menopausal symptoms and possibly protect women from cancers.
But in 2002, doctors did an about face when new studies came out suggesting that hormone replacements were actually increasing the risk of cancer in women. These new studies were longer, had more women enrolled, and more money thrown at them. It was a passionate topic around women’s health, affected a huge segment of the population, and lots of money was at stake with new product lines.
The HRT reversal happened in my last year of medical school. I then went on to residency where I had to apply all of these findings from the studies I’ve read to real patients’ lives. I quickly learned that applying population-based studies to individual patients’ lives was almost impossible. Scientific evidence was simply one of the means you had to support your intuition, the “art of medicine.” Most “evidence-based” medicine is for issues where an entity stands to make money or the issue is extremely important to the entire population because it deals with decisions around therapies for large amounts of people.
If this sudden reversal in best practice happened with hormone replacement therapy and:
- there was significant money involved
- the studies were very large
- the studies were long
What about the tens of thousands of other medical issues that don’t have massive resources, passion, large amounts of participants, and long time frames? What are we to believe when a massive amount of money and people can’t give us a definitive answer? The latest “evidence” or the long term reality that large population-based studies have very little meaning to individuals? Or do we just accept medical science as a moving target and claim that we’re doing the best we can do? Will our culture accept the fact that medical science is actually a moving target both in and out of the courts?
see also, this:
Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right…