THE MEDICAL INDEPENDENT | 10 FEBRUARY 2022
22
Opinion
Questioning the notion of ‘settled science’ It was scepticism, not unthinking belief, that prompted the emergence of modern medicine from the swamp of mumbo-jumbo GEORGE WINTER Read more by George Winter at www.mindo.ie
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acteriologist Sir Almroth Wright (1861–1947) was Alexander Fleming’s boss and a great chum of George Bernard Shaw. Shaw made Wright the hero of his play The Doctor’s Dilemma (1906), where he appears as Sir Colenso Ridgeon. In Act 1 Ridgeon observes: “Opsonin is what you butter the disease germs with to make your white blood corpuscles eat them,” and I can imagine Shaw quizzing Wright on the truth of that line, with the latter modestly offering one of his better-known dictums: “Before making a decision on any subject, a man should always have numerous conversations with those who are expert in it.” Confirming that his intellectual reach extended beyond his grasp of germs, Wright penned a letter to The Times, which was published on 28 March 1912 and in which he discarded all traces of diffidence to divulge that he was an “expert”. Wright’s letter explained his opposition to female suffrage by claiming that women’s participation in politics was made intolerable because of their physiology. Militant suffragettes, furthermore, were immoral, sexually embittered, and in his “expert” opinion “… there is mixed up with the women’s movement much mental disorder”. A century later, it is unlikely that a contemporary purveyor of such misogynism would be invited onto the airwaves, yet a warm welcome awaits those who yield to the temptation of a daytime-telly sofa by permitting themselves to be described
as an expert in something or other. But before lowering themselves onto a turquoise-hued Chesterfield they should remember that we live in an age where expert opinion is no longer accepted without demur. For example, in July 2005 the General Medical Council (GMC) struck off paediatrician Professor Sir Roy Meadow after finding him guilty of serious professional misconduct for giving “misleading” evidence in the Sally Clark case. Mrs Clark served three years in jail after being wrongly convicted of murdering her two sons, but she was exonerated after an appeal in 2003. During her trial, Sir Roy asserted that the probability of two natural unexplained cot deaths in the family was 73 million to one, a figure subsequently challenged by the Royal Statistical Society. The chairman of the GMC panel told Meadow: “You should not have strayed into areas that were not within your remit of expertise.” Like Wright, Meadow assumed that being an expert on something gives you range, whereas it only gives you focus. The word “scientist” was first coined in 1834 by William Whewell (1794–1866) in an article for The Quarterly Review on Mary Fairfax Somerville’s book On the Connexion of the Physical Sciences. Up until then there had been “friends of science”, “cultivators of science” and “interpreters of nature” … but Whewell levered “scientist” into the language only relatively recently. Those who throw a protective cloak of “settled science” around what they consider sacrosanct areas of scientific knowledge when challenged by new evidence should remember physicist Dr Richard Feynman. The Nobel laureate who discovered the cause of the 1986 Space Shuttle disaster – and who JG Ballard praised for his ability “to tackle any problem in the most direct and simple way, ignoring the accumulated mass of conventional opinion” – defined science as “the belief in the ignorance of experts”.
But the internet can make us all experts – or so we think. The combination of universal access to data and self-absorption means that we mistake information for knowledge, we mistake knowledge for wisdom and there are few who can point out the difference. Might objectivity be nothing more than an illusion? The notion of scientific objectivity was considered by molecular biologist Jacques Monod in his Chance and Necessity (1972). According to Monod, nature itself is objective because it lacks purpose. This prompted philosopher Dr Mary Midgley to pose this question in her Science as Salvation (1992): “… as he too was part of nature – was his own purpose in writing his books real or not? He doesn’t say.” More recently, the purpose of Dr Daniele Fanelli writing in PLoS ONE (2010; 5: e10271) was to ask whether academia’s publish or perish culture might “conflict with the objectivity and integrity of research, because it forces scientists to produce ‘publishable’, results at all costs”. Fanelli cites evidence to show that competition in academia can be seen as a threat to scientific integrity. Whether it’s, say, the origins of heart disease, stomach ulcers or Covid-19, those who express scepticism about evidence adduced by so-called experts – whose opinions are often promoted without question by an apparently compliant mainstream media – are portrayed as “denialists” by those who shrink from disturbing the sleep of reason. But they forget that it was scepticism that prompted the emergence of modern medicine from the swamp of mumbo-jumbo. As the late Prof Roy Porter observed: “Medicine is an enormous achievement, but what it will achieve practically for humanity, and what those who hold the power will allow it to do, remain open questions [my emphasis].”
MCQs MULTIPLE CHOICE QUESTIONS
A. At one month, turns eye in direction of sound. B. At six months, development of sound localisation. C. By eight months, responds to name and simple commands. D. By two years, incessant talk. E. At four years, hears ticking of wristwatch three inches to right and left.
Question 4
In the treatment of chronic gout, allopurinol A. Acts by increasing urate excretion in the urine. B. Possible side-effects include alopecia. C. Should not be prescribed with NSAIDs. D. Dose should be titrated up, in 100mg increments, from 100mg a day. E. Use is contraindicated in patients with renal impairment.
Question 5
Correct advice to give to patients with colostomies includes A. Bleeding around the outside of the stoma when changing the appliance is normal. B. Experiment with your diet. C. Never use laxatives. D. Consult the doctor if you experience the sensation of rectal fullness. E. Parastomal hernias are better repaired while small.
speech failure. E. TRUE. Also hears whisper at same distance.
Recognised auditory developmental milestones include
ANSWER 1 A. FALSE. Is caused by Coxsackie virus. B. FALSE. Young children are most affected. C. FALSE. May also affect the nappy area. D. FALSE. The patient may be febrile and unwell. E. FALSE. Within about a week.
Question 3
ANSWER 4 A. FALSE. Xanthine oxidase inhibitor that reduces urate production. B. TRUE. Also nausea and raised liver enzymes. C. FALSE. May be needed to treat flares due to urate crystal shedding into the synovial fluid when starting treatment. D. TRUE. Most adults require 300-500mg daily to maintain serum urate below 360μnol/l (6mg/dl).
A. Age alone is the strongest risk factor for fatality. B. The majority of patients present with confusion. C. Respiratory rate over 20 per minute should prompt hospital admission. D. First-line antibiotic of choice is amoxycillin. E. Follow-up is important.
titrate in smaller increments.
In older patients with community acquired pneumonia
E. FALSE. Start at 50mg and
Question 2
ANSWER 2 A. FALSE. Comorbid disease, malnutrition, functional disability, cognitive impairment, are more important. B. FALSE. With tiredness, breathlessness, pleuritic chest pain, cough. C. FALSE. Over 30 per minute. D. TRUE. 500mg to 1g three times a day. E. TRUE. Eg, 16 per cent of male smokers will have an underlying lung cancer.
A. The cause is herpes simplex virus infection. B. Teenagers are most likely to be affected. C. The vesicular rash is confined to the hands, feet, and mouth. D. There are little or no systemic symptoms. E. Spontaneous resolution occurs within two-to-three days.
ANSWER 5 A. TRUE. From overzealous cleaning. B. TRUE. Many people who have had ostomy are able to eat anything. C. FALSE. Osmotic or bulkforming laxatives are preferable to stimulant types. D. FALSE. 70 per cent of patients will experience this a year after stoma surgery. E. FALSE. The majority are asymptomatic and only 10 per cent will require surgical correction if strangulated or severely affecting the patient’s quality-of-life.
In hand, foot, and mouth disease
ANSWER 3 A. FALSE. At one month will briefly quieten to sound. By three months dislikes harsh sounds and will turn eye in direction of sound. B. TRUE. First horizontally, then below and above ear level. C. FALSE. Not until about 12 months. D. TRUE. Remember hearing screening may be directly for deafness or for consequent
Question 1