Science: A Playground for the Perpetual Child

Yesterday I read a hardcore Genetics textbook. As I thumbed the pages, simultaneously struggling to appreciate the concepts behind the words and reveling in the wonder of our being, I was struck by the fact that I love to learn. Both friends and self would have flagellated me had I stated that fact (or even felt it) as a young man or child.  Studying and learning were fancies of the nerds. Now I reflect on childhood, mine as well as that of our children. I recall mostly the experiences of our three infants and toddlers. They perpetually tested their environment. The distance of a jump, height of a tree climb, method of a toss, or speed of a swing: Everything was under scrutiny because everything was to be improved. They’d try different methods to accomplish their latest feat and after failure upon failure they’d find a way to succeed. Sometimes they’d later revise their techniques, using the wisdom of age and experience as their guide. In essence they were continuously studying and experimenting on themselves and their environs. They not only loved to study; they lived to study.

Today I find myself in a similar place. No longer able to accomplish past physical achievements, I am relegated to handsprings of the mind. I think and learn voraciously. What I learn, I teach. Though I miss the physical challenges and conquests of youth, this phase of life has plenty to offer. Often I communicate with similarly minded colleagues to discuss the latest and greatest ideas and discoveries. What fascinates us most though, and lures us in more than anything else, is our perpetual amazement by the bottomless well of knowledge from which we draw. It is not intimidating; it is invigorating. Our understanding takes us back in time, to the adventures of childhood. Science is an endless quest for very old children; a fearsome ride one never wants to leave. The adage, “the more you know, the more you realize how much you don’t know” is not only true, it’s tantalizing. It embodies the glory that keeps us steadfast in the game while we are fortunate enough to remain above ground.

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Caution! Always View Clinical Trials with a Healthy Dose of Skepticism

We are barraged by data. In medicine this comes in the form of clinical trials and reviews. In everyday life data from news outlets strike us at every turn. We also have the internet and TV talk shows. Everyone seems to have an opinion about everything. So how do we separate the wheat from the chaff? When it comes to science, this is what I advise.

First, understand that science is not static; it is a process. It is also not black and white; it comes in countless shades of grey. Published studies are attempts to find biologic connections. They are single links in the chain of understanding. They do not stand alone; they always must be viewed in the context of all other clinical trials as well as our understanding of the complexity of human biology. Never though do we gain a hotline to god. Never are we able to say, “this is truth and all else fiction” after the publication of a clinical trial. So if you hear or see someone go to a place of certainty on the basis of a single trial, be very, very skeptical. Even if that individual is a so-called expert. The experts are not gods.

Second, there are levels of importance among the trials; some therefore are “better” than others. Rarely do you hear even the experts on TV speak about this. They typically speak only about the “abstract”, a brief summation at the beginning of every study. This is an area too complex for most clinicians to fully grasp. How then can we expect the lay population to comprehend this nuance?

Third, and probably most important of all, every trial comes with flaws. Sometimes these imperfections entirely devalue the trial’s results; other times they simply raise cause for concern. Regardless, to do a trial justice, one must read it with a fine tooth comb. In fact, when I really need to understand a particular study I spend four or five hours reading and critiquing it. Imagine that; four or five hours for a single trial. How then can I treat patients, teach, write, and still have time to read the many thousands of trials published annually. I can’t.

In sum, be cautious. Do not jump to conclusions when a study is published. Do not panic. Do not stop your medications or supplements until you’ve had the opportunity to discuss the findings thoroughly with your doctor. Always be circumspect and vigilant when learning about a clinical trial. Always maintain a very healthy skepticism. I guess in the final analysis the truth is that you can’t always believe what you read or hear. Competing interests often get in the way of truth. And the truth with clinical trials is that they are not at all about “the truth”. They are simply small cogs in the wheels of discovery.

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Clinical Trials and Scientific Articles: Read and Believe with Caution

A disclaimer should accompany every scientific article, “Read and Believe with Caution”. To say that weekly there is a study contradicting a prior clinical trial is probably an underestimation of the state of medical/scientific affairs. Hundreds of peer-reviewed journals now cross our desks and computer screens. How do we, the doctors and scientists, assimilate all these data? This is particularly difficult when one considers the complexity of statistical analyses that must be thrashed through in order to do justice to any single study. And then one must remember that we do not have every hour of every waking day to analyze trials. The result is far too often a leap to erroneous but easy conclusions. We saw this recently with a JAMA meta-analysis regarding fish oils (see the blog of my letter to JAMA) wherein standard statistical analysis was plainly deviated from. The result, an unfounded conclusion that no one on TV every mentioned. Perhaps they did not have the preparatory time necessary to dissect the statistics. Whatever the case, medical and lay opinions were unfairly and wrongly influenced by this trial.

And now we have another interesting study, this time in favor of supplements. On October 17th JAMA published on-line the results of a multivitamin analysis of Harvard’s famed Physicians’ Health Study. This trial revealed that simple (low dose) multivitamins could decrease cancer rates in men. Prior studies using high dose supplements have failed to demonstrate this. At the risk of being self-serving, over ten years ago I performed a small clinical trial (published in JANA – the Journal of the American Nutraceutical Association) demonstrating the possible downside of high-dose supplements. I responded to my own trial by forming a very conservative supplement company, VitalRemedyMD.  And my first products were two simple daily multiples with no more than 100% of the RDV of the essential vitamins and minerals (the Daily2Tab and DailyMultiple – innovative names, I know). No more than that. I based these formulations more upon my review of basic science literature, than our too-highly-revered RCT (Randomized Clinical Trials). A decade later, the clinical trial is “catching up” with something that science had already taught us. My point here is that we in the medical world have shunned our roots, basic science. And, we have cut ourselves off from our mentors, the basic scientists. In fact, just last week an article I wrote on this subject that was published online – A Survey of Internists and Cardiologists: Are Discoveries in Fatty Acids Truly being translated into Clinical Practice? Prostaglandins, Leukotrienes and Essential Fatty Acids (available online 25 October 2012). It tells this story. There is a disconnect between science and medicine. It is real, prevalent, and very disturbing. It undermines our ability to grow and limits our capacity to cure. The only way I see we can conquer this impediment is by opening a continual and non-confrontational dialogue among the diverse elements of science and medicine. Only then can we have true translational medicine, the application of what is learned in the lab to the patient in our offices or hospital wards. Short of dialogue we will continue to exist in a modern tower of babble, and we all know how well that worked out.

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