THE SCIENCE BLUES

Larry Dossey, MD

the blues: a depressed, unhappy feeling
- Webster's New World Dictionary

For some time now I've felt like a jilted lover. The pas­sionate love affair I developed with science when I went off to college as a teenager is dying. I thought my infatuation would last forever, but gradually I've real­ized that something has gone terribly wrong. My early adoration of science has been replaced by wariness and suspi­cion. These days I'm on 24-hour alert for betrayal. You might say I've got the science blues.

My disappointment with science, I admit, is largely my own fault. I was hopelessly romantic. I expected more from my lover than she could possibly live up to. Now I'm paying, as my inflat­ed expectations have come back to haunt me.

But, truth be told, the fault is not entirely mine. Science teased and seduced me, adorning herself with layers of paint and glitter that concealed flaws I never suspected. Her emissaries, sent ahead to make introductions, lied out of their teeth. They exaggerated her dowry, inflating what she had to contribute to our arrangement. I could have endured a few lies; it was when the actual abuse set in that I began to wake up.

Don't misunderstand me. I haven't given up. I'm still terri­bly attracted to her and I'm sure I always will be. I keep hoping she'll change. If she does, there's a chance our love might rekin­dle. But even if we do make up, things could never be the same. I would set conditions. For one thing, I'd require that she listen to me for a change. My feelings count, too, you know.

As a precondition for reconciliation, I'd require that she get into therapy, maybe with a group, where she could hear com­plaints from others who feel the way I do. Then maybe she'd real­ize she's been living in a dream world, unaware of the pain she causes practically everyone she meets.

I've talked to a few people about our crumbling relation­ship. One colleague says I'm entirely to blame. He accused me of being a traitor to science. He doesn't understand that the prob­lem was always too much commitment, not too little. He doesn't realize that for decades I kept trying to make things work out, always giving science the benefit of the doubt. I was sure I was the problem. That's why I kept coming back for more, until one day I realized I couldn't take it anymore.

HALF THE POPULATION

I've spent weeks reading commentaries by scientists about why they think society increasingly rejects or misunderstands science. Almost all of these analysts imply that it's the fault of laypersons--the nonscientists--that things are out of whack. But there's hope. The scientists believe these misperceptions can be educated out of folks. If they can make society more "scientifi­cally literate," people will wake up once more to the wonders of science and the old love affair will bloom again.

KNOTTED ELECTRIC CORDS AND FAKED MOON LANDINGS

THE SCIENTIST'S BLUES

Computer scientist Douglas R. Hofstadter [3] of Indiana University in Bloomington, author of the Pulitzer prize-winning book Godel, Escher Bach, [4] believes that society is pervaded by a deep, unconscious, anti-science bias. The general public, he laments, no longer views science with a sense of awe and mys­tery, but considers it mundane, conservative, devoid of mystery, boring, close-minded, and a negative force in society. Instead of being grateful for the revelations of science, we've embraced

so-called "mysteries" such as after-death experiences, alien abductions, crystal channeling, crop circles, telekinesis, clairvoyance, extrasensory perception, [and] remote view­ing.... Movie and television viewers and readers of serious literature are given the tacit message that the line between the natural and supernatural is blurry, and perhaps even nonexistent.... Scientists are represented in movies, televi­sion, and books as heartless, humorless nerds who would sooner kill than smile, sooner write abstruse formulas than make love." [3( p512)]

Physicist and science historian Gerald Holton [5] of Harvard University blames educators for this state of affairs. He worries about the insidious creep into higher education of postmod­ernism, which questions the objectivity of scientific observation and the truth of scientific knowledge.

So, if society has the blues about science, scientists have the blues about being rejected. Some of them don't have a clue about how to patch things up. Hofstadter [3(p512)] confesses: "I have no quick fixes. I do not know how to quickly and easily repair decades of damage. I do not fully understand why the sands have shifted so radically. All I can do is look on in sadness and worry about the future of rational inquiry, bemoaning the loss of awe toward genuine mysteries that our society was once lucky enough to possess." (Psssst, Dr Hofstadter! Here's a hint about fixing things. As a first step, stop being so sanctimonious and self-righteous!)

Hofstadter's comments, which appeared in 1998 in Science, one of the profession's flagship journals, are typical. There is not a glimmer of recognition that science and scientists might be a part of the problem.

THE FLIGHT FROM MYSTERY

I know, I know. Scientists claim to high heaven that they fol­low mystery wherever it leads, but this statement would be con­sidered perjury in any court in the land. Sadly, when science confronts some mysteries it turns tail and runs. It is no wonder that an increasing number of people perceive science not as the friend but the enemy of mystery and awe.

This situation is played out in doctors' offices thousands of times each day. Surveys [6-8] show that roughly 40% of the American population visits some sort of CAM practitioner every year, which exceeds the total number of annual visits to primary care physicians. These surveys also reveal that most people don't tell their physician they are using CAM-type therapies, many of which are mysterious in the sense that their mechanism of action is unknown. Why don't patients open up? They don't want to be hassled, condescended to, or put down. They have no confidence that their doctor can behave like a genuine scientist--someone who can put prejudice aside and objectively honor the evidence for the therapy in question.

Most physicians would consider this an unfair accusation, but I believe it is practically the norm. Here's another example of how the flight from mystery works. During my 1999 book tour for Reinventing Medicine, [9] I was interviewed by a reporter for a leading newspaper in New York City. She was interested in the role of dreams in healing, for which there is much historical precedent and a growing body of experimental and clinical evi­dence, as I made clear in the book. As an objective journalist, she phoned Arnold Relman, MD, former editor of the New England Journal of Medicine, for a second opinion. Relman [10] commented: "Unless we are living in a dream, what he says has to be nonsense." So much for awe and wonder, for following mystery wherever it leads.

CME FOR THE BLUES

I've given a lot of thought lately to why I have the science blues. Here are a few of my reasons.

DOUBLESPEAK

This hardly scratches the surface of the twisted ways scien­tists have of thinking about consciousness these days. The Strangest is what is being called the "zombie" school of con­sciousness"--the idea that we think we're conscious but aren't. The basic idea is that consciousness is, again, an illusion. We're on automatic, wandering around like automatons. Those who hold this view seem to think it applies to everyone but them­selves. They exempt themselves from zombiehood, for if they didn't they'd have to admit they are speaking zombie nonsense over which they have no control.

TAKING OVER: SCIENCE'S WAR ON VALUES

Science offers no moralfoundation for the personal conduct of life.
- Albert Einstein [15]

A major reason for the widespread disenchantment toward science is the perception that it has gotten too big for its britch­es. Scientists have a way of extending their authority beyond their competence--for example, when they denounce the values and meanings people find in their lives and substitute their own.

Ideally, scientists form hypotheses, do experiments, gather data, make predictions, and so on. Scientists, however, have no way of knowing what their hypotheses and data mean. They can tell us that cholesterol clogs arteries and causes heart attacks, but they can't say whether this is good or bad. They can tell us how to lower cholesterol, but they can't attach a value to doing so. It is up to each individual, not scientists, to place a value on such matters. In spite of this profound limitation, scientists often behave as if they have privileged insight into what is mean­ingful and valuable. This is of course nonsense. [16]

Many scientists, even great scientists, are unable to resist preaching values, even while claiming that science is value-free. A famous example is the late Nobel prize-winning molecular biologist Jacques Monod, who was extremely influential in shaping the philosophy of science in the second half of the 20th century. In his widely read 1971 book Chance and Necessity, Monod [17] states that the world has "been molded by the free play of physical forces to which we cannot attribute any design, any 'project'or purpose." For him, "[t]he cornerstone of the scientif­ic method is the postulate that nature is objective. In other words, the systematic denial that'true'knowledge can be got at by interpreting phenomena in terms of final causes--that is to say, of 'purpose.'" [17]

Monod was utterly uncompromising: "Knowledge in itself is exclusive of all value judgment ... " [17(p174)]; "In an objective system ... any mingling of knowledge with values is unlawful, forbidden" [17(p176)]; "It is perfectly true that science outrages values. Not directly, since science is no judge of them and must ignore them .... " [17(p172)] Monod's austere vision continues to express the credo of the vast majority of respectable, paid-up scientists: the natural world means nothing; it merely does what it does.

Monod reserved special scorn for people who saw values, goals, and purposes in nature. One of his favorite targets was the paleontologist and Jesuit scholar Pierre Teilhard de Chardin. "For my part," Monod huffed, "I am most of all struck by the intellectual spinelessness of [his] philosophy. In it I see more than anything else a systematic trucking, a willingness to concili­ate at any price, to come to any compromise."[17(p32)]

Yet, in summing up, Monod engages in a breathtaking reversal. He advances a set of grim values and meanings he derives from the findings of science. He concludes [17(pp172-173,180)]:

If he accepts this message--accepts all it contains--then man must at last wake out of his millenary dream; and in doing so, wake to his total solitude, his fundamental isola­tion. Now does he at last realize that, like a gypsy, he lives on the boundary of an alien world. A world that is deaf to his music, just as indifferent to his hopes as it is to his suf­fering or his crimes.... The ancient covenant is in pieces; man knows at last that he is alone in the universe's unfeeling immensity, out of which he emerged only by chance. His destiny is nowhere spelled out, nor is his duty. The kingdom above or the darkness below: it is for him to choose.

Denying the presence of meaning in science and then using science as a source of meaning, whether positive or negative, is hypocrisy. Many scientists are like Monod--busybodies who just can't resist inflicting their values on others. We expect this type of advice from religious leaders, because meanings and values are their business. But when this sort of advice comes from scientists, it rubs people the wrong way and is a root cause of the science blues.

Another example is Richard Dawkins, the famous British evolutionary biologist. Like Monod, Dawkins can't resist flogging us with negative meanings and denying he's done so. Dawkins is famous for the concept of the "selfish gene," the idea that we are slaves to our DNA. All our behaviors and thoughts, including our sense of choice and freedom, are illusions. We shouldn't take it personally, Dawkins says. Our genes are on automatic, doing what they've been designed to do over millions of years of evolu­tion. They are blind, thoughtless survival machines that are using us to perpetuate themselves, and we are merely along for the ride. All this, Dawkin says, makes them "selfish"--thus the name of his wildly popular book The Selfish Gene. [18] But if our genes are on automatic and can't help what they are doing, why call them self­ish? Why imbue them with feelings if they can't feel? Why attribute motives to them if they have none? Why assign meaning to genetic behavior after denying there is any? This is the sort of anthropomorphic projection Dawkins permits himself, yet for which he famously excoriates others.

The assault on spiritual meaning is a major problem for the field of CAM. Stanford researcher John A. Astin found in a national survey that there is a strong spiritual foundation underlying the acceptance of CAM by the American public. [8] Writing in the Journal of the American Medical Association in 1998, Astin reported that

users of alternative health care are more likely to report having had a transformational experience that changed the way they saw the world.... they find in [alternative therapies] an acknowl­edgment of the importance of treating illness within a larger context of spirituality and life meaning.... The use of alternative care is part of a broader value orientation and set of cultural beliefs, one that embraces a holistic, spiritual orientation to life.

The reason science's negative attitude toward spirituality is a problem for CAM is straightforward. If you believe, as many scientists do, that spirituality and medicine don't mix, then the spiritual aspect of CAM can be used a pretext for trashing the entire field, evidence be damned.

Dr William Harris and his colleagues [19] of the Mid-America Heart Institute at St. Luke's Hospital in Kansas City, Mo, ran into this reaction when they published their double-blind controlled trial of intercessory prayer in the Archives of Internal Medicine on October 25, 1999. The study showed about a 10% statistically sig­nificant advantage favoring the prayed-for heart patients. Harris's paper evoked a blizzard of criticism in the letters to the editor following publication. One physician said that the effects of prayer should be dismissed because they would be indistin­guishable from clairvoyance and telepathy, which, he implied, are nonsense. Prayer cannot operate at a distance, he said, because this would require us to "suspend natural law," resulting in "pseudoscientific mischief." Harris and his colleagues were accused of taking "a P value out of context" and allowing their P value to get "out of control." One critic saw heresy and blasphe­my: the researchers were "putting God to the test." Another implied that Harris was subverting the entire edifice of modern medicine; the critic was "concerned with the potential effect of the study and its publication on the reputation of hospitals involved and on the integrity of health care organizations in gen­eral." The nitpicking reached gutter level when one individual pointed out in an unpublished letter that Harris used the term "coronary care unit" in one place and "cardiac care unit" in another. Which was it, he demanded to know.

Sometimes, however, science gets it right in how it responds to people's religious views. An encouraging example took place in 1998 when the National Academy of Sciences issued an elaborate guidebook for teachers that recommended how evolution should be taught in schools, and how the questions of students and par­ents could be answered. [20] Academy leaders insisted that they were not trying to destroy religious beliefs. They noted in the guide that people can believe in evolution and God at the same time. It acknowledged that the theory of evolution is silent on where life came from initially. How did the first cell originate? "That one is still up for grabs," said academy president Bruce M. Alberts.

It's refreshing to see that scientists can resist the temptation to put people down for their religious views. If they did this more often, they would have less cause to complain about not being appreciated and understood.

THE DEBUNKERS: SAVING SCIENCE OR DAMAGING IT?

The most visible of these organizations is the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP, pronounced "sigh cop"), publishers of The Skeptical Inquirer: The Magazine for Science and Reason, which has a circu­lation of approximately 50000. [21] Among the 77 fellows listed by CSICOP are 5 Nobel prize winners in science. This sounds as if the organization tirelessly investigates controversial claims, but this is a misleading picture. CSICOP is mainly an arm-chair orga­nization that seldom dirties its hands with actual research. According to a 1992 analysis of CSICOP by George P. Hansen, [22] "[d]espite the name of the organization, actual research is a very low priority of the Committee. In fact, CSICOP instituted a poli­cy against doing research itself. CSICOP's highest priority has been to influence the media. Its rhetoric and activities are designed to appeal to a broad audience rather than to scientists who investigate unusual or controversial phenomena" (note 1).

CSICOP is virulently hostile to parapsychology--telepathy, clairvoyance, precognition, and psychokinesis. They also oppose distant healing and intercessory prayer--anything, in fact, that does not fit within a strictly materialistic interpretation of nature. CSICOP also holds the field of CAM in disdain. For example, debunker and physician Wallace Sampson," an ardent foe of CAM, says, "'alternative' and 'complementary' are euphemisms for 'It doesn't work.'"

Some observers believe that CSICOP and other debunking organizations are a major cause of the science blues because, in their attempt to save science, they are creating a public backlash. Consider, for example, that more than half of the adult popula­tion in the United States has had psychic experiences and believes in the reality of these phenomena. [24-27] As Hansen [22(p51)] states: "Those who have had [these] experiences but encounter the debunking attitudes of apparent 'scientific authorities' are likely to conclude that science is a dogma and inapplicable to impor­tant aspects of their lives." Parapsychology researcher Jacques Vallee [28] goes further. He suggests that debunkers "are among the primary contributors to the rejection of science by the public."

BACKTRACKING

In the United Kingdom ... issues [of confidence in sci­ence] are much in the public mind, in the continuing after­math of the fiasco over bovine spongiform encephalopathy (BSE, or mad cow disease). After years of assurances from government agencies that this strange neurological disorder in cattle posed no threat to human health, Stephen Dorrell, the British health minister, admitted in March 1996 that there was an almost certain link between BSE and an out­break of the fatal Creutzfeldt-Jakob disease centered in England. The ultimate source of the human infection appears to have been cattle feed made from sheep that were infected with scrapie, a disease related to BSE. Apart from its still unknown number of human victims, the episode eventually led to the slaughter of millions of cattle and the near destruction of the British beef industry. The episode has resulted in a perfectly reasonable public skepticism about the accuracy and honesty of scientific predictions about the consequences of changes to the food chain.

People are increasingly suspicious when scientists assure them something is safe. Is irradiated food as benign as scientists claim? What about genetically engineered crops, which most sci­entists herald as a risk-free boon to the human race? Millions of people are dubious of these assurances, half-expecting scientists one day to reverse their stand on these matters as they did with mad cow disease. People don't demand that scientists be omni­scient. They just want straight talk, which they believe they often don't get from scientists these days.

BUNGLING

But less than 3 months later it happened again. On Decern­ber 3, 1999, the $165 million Mars Polar Lander disappeared without a trace. The reason, a review panel theorized, was a sim­ple software glitch that easily could have been fixed. The glitch duped the lander's engines into shutting down about 10 seconds before landing. Without its rockets acting as brakes, the lander crashed into the frozen Martian surface at 50 mph and broke up on impact. [31]

"Everybody's entitled to one stupid mistake, but now there are two stupid mistakes," said Rep Dana Rohrabacber (R-Calif), chair of the House committee that funds NASA. [31(p46)]

NASA's foul-ups were clean--nobody suffered or died as a result. When medical experts make technical mistakes, however, the outcome can be tragic.

When Nancy Seeger, 56, of Evanston, Ill, was 14 years old, her mother died of breast cancer; 5 years later her mother's sister died of the same disease. [32] So, when researchers a few years ago developed a test for a gene defect that predisposes women to both breast and ovarian cancer, Seeger decided to undergo the test after deliberating long and hard with her physician. The test returned positive. In tears, Seeger read the report, which indicat­ed that she had a lifetime risk as high as 85% for breast cancer and 50% for ovarian cancer. The test results, said the letter, had been "confirmed independently."

Given the odds, Seeger went into action. She decided on surgery to have her ovaries removed prophylactically. While recuperating from the operation and contemplating removal of both breasts, she received a call from her doctor. As gently as possible he informed her that the test had been wrong. A second test, done on a sample of blood she had donated for research, had detected the error. The original lab mailed her a letter apolo­gizing "for any anxiety or stress this situation may have caused," and refunded her $350 fee. Seeger was not placated. In October 1999 she filed a lawsuit against the lab, Oncormed, and the com­pany that later acquired it, Gene Logic, which has reportedly ceased doing the test.

Accidents happen and nobody is perfect. Yet events like these erode public confidence in science and cast doubt on the glowing predictions scientists often make.

THE DISTRUST OF AUTHORITY

Beginning in the 19th century [with the rise of science], ... cultural authority began to shift from elders (whose claim was rooted in life experience) to technical experts (whose claims were rooted in specialized education, language, etc). Society gained something in the process (legitimate experts can do some good), but it had to turn over control of expert activity (including accreditation, licensure, etc) to "peer review" because only another expert could understand what was involved. Unfortunately it is in the interests of such expert communities ("peers") to expand their sphere as far as possible. Nothing cynical here, just ordinary poli­tics and bias among largely sincere people.

As a result, freed from public control, and justifying insti­tutional change and growing political clout in terms of the public good (conquest of disease, ... cheap and abundant food, etc) experts over the span of about 100 years divided up 100% of life and the universe among themselves. That left nothing the ordinary person could claim to really know and understand-and the result has been constant conflict and disillusionment: Go to Vietnam and fight, it is neces­sary and victory is inevitable; have your baby in the hospi­tal, it's safer; take your medicine, doctor's orders; this is a normal family structure, so if you are a homosexual you need treatment; pesticides are safe and necessary for agri­culture; antibiotics will eradicate infectious disease; etc.

And then, of course, trust us! Even in theology experts told their congregations about what was and was not valid spiritual experience. And more and more people noticed (1) that their experience conflicted with expert pronounce­ments, and (2) that the promises of the experts about what they could deliver were largely empty. We got Silent Spring; southeast Asia turned out to be a debacle; as gay and les­bian folks came out they turned out not to be aliens with horns, but our sisters and brothers; midwife-attended home birth is safer in healthy pregnancies; drug resistant bacteria; pesticide resistant bugs; the ozone hole and global warming. In religion the charismatic movement, the new New Age and the fundamentalisms that are a response to oppressive, spiritually and doctrines.

Authority is necessary for the lessons of experience to be broadly accessible. Without authority each person knows only what their own experience has taught them. But authority requires legitimacy. Cultural authority rests on the belief that good reasons could be provided if necessary. Authority replaces personal judgment, but only as long as good evidence and argument are believed to be in reserve. And that belief doesn't last forever, if it is mistaken. When authority is hypertrophied, the eventual response invites a cynical rejection of all authority as mere ideology and the exercise of power....

To anyone involved in the practice or research of CAM, Hufford's comments will probably remind them of incidents in their own lives when the authority of science fell on them.

Hufford relates an incident in which he was involved--a conference on CAM in Philadelphia, November 10, 1999--that speaks volumes about how science is weighted against CAM. Dr Marcia Angell, executive editor of the New England journal of Medicine, presented her views about publishing studies in CAM. While disclaiming any bias against good scientific studies of CAM, Angell said that to be good a study must offer a plausible biological mechanism for any effects that are reported. Otherwise the study could not be believed. This means, she explained, that therapeutic touch, homeopathy, moxibustion, and intercessory prayer are "preposterous" and "impossible" because they lack a plausible biological mechanism, and that studies of these practices are only being published for social and political reasons. [33]

To say that something is implausible means that it doesn't fit with currently accepted theories. But how can science grow if the only studies that are published are those that confirm ideas already in place? And, of course, what we consider plausible depends largely on what we are familiar and comfortable with. How can we become familiar and comfortable with new concepts unless studies about them are published? Moreover, scientific puz­zles do not spontaneously solve themselves. How are the great mysteries to be understood unless researchers take a stab at them?

A ruckus over plausibility took place in England between famous scientists over a century ago. The dispute involved telepathy, clairvoyance, and psychokinesis, which suggest that consciousness can operate remotely. Nobelist Sir William Crookes (1832-1919), the discoverer of thallium, favored the investigation of these phenomena even though they could not be explained. He contrasted his approach with that of fellow physi­cist Michael Faraday (1791-1867), famous for his work in electric­ity and magnetism, who bitterly opposed them. Crookes [34] stated:

Faraday says, "Before we proceed to consider any question involving physical principles, we should set out with clear ideas of the naturally possible and impossible." But this appears like reasoning in a circle: we are to investigate nothing till we know it to be possible, whilst we cannot say what is impossible, outside pure mathematics, till we know everything. In the present case I prefer to enter upon the enquiry with no preconceived notions whatever as to what can or cannot be.

We should be cautious in rejecting events as implausible, because subsequent developments may reveal that our notion of plausibility reflected little more than our own ignorance. For example, when Newton advanced the notion of universal gravity in the 17th century, his colleagues condemned his ideas as implau­sible and a sellout to mysticism. [35] Most scientists today probably believe they would not have been as hidebound as Newton's doubting colleagues, but in 1995 "an editorial in the journal Nature questioned whether Newton would have been able to pub­lish his theory today, given its self-evident preposterousness .... " [36]

Over the past 2 decades we've seen many CAM therapies condemned as implausible--acupuncture, exercise, nutritional supplementation, meditation, biofeedback, and others--only to win eventual endorsement and acceptance within conventional medicine. No wonder the public is leery when experts say a par­ticular CAM therapy can't work because it's implausible.

Experts who are hung up on the plausibility of CAM thera­pies ought to get out more. They might actually try biofeedback, acupuncture, or yoga--not because personal experience consti­tutes irrefutable proof, but because personal experience shapes our worldview, our concept of what is possible and plausible.

IGNORING EVIDENCE

Scientists typically understand science about as well as fish understand hydrodynamics.
- John Dupré [37]
"The Fight for Science and Reason"
The Sciences

A related reason people have the science blues is the way scientists often ignore evidence. I've seen this happen often in a field I'm personally interested in--intercessory prayer and dis­tant healing. As I've often mentioned in this column, there is a considerable body of evidence attesting to the nonlocal effects of prayer and healing intentions, including double--blind studies in both humans and nonhumans. [38] Yet skeptics continue to belittle this field by claiming that serious scientists aren't religious and that prayer research is not a fit concern. For instance, Hufford reports that at the above-mentioned Philadelphia conference, Dr Arnold Relman, former editor of the New England Journal of Medicine, asserted that science denies religion and that very few scientists are religious, except for a few Deists (deism is the belief in the existence of God on purely rational grounds without reliance on revelation or authority). Relman is wrong. For almost the entire 20th century, surveys have shown that 40% of American scientists believe in a personal God, according to data published in the prestigious science journal Nature. [39]

How can authorities stray so far from the facts? One reason is that they simply don't keep up. Consider intercessory prayer again. Most scientists who consider prayer implausible are unaware not only of the experimental studies, but also of theory development in this field. They don't realize that consciousness research is buzzing with hypotheses that permit the sort of non­local mental actions seen in prayer, such as those advanced by Nobel physicist Brian Josephson, [40] physicist Amit Goswami of the University of Oregon's Institute of Theoretical Science, [41] mathematician and cognitive scientist David J. Chalmers, [42,43] sys­tems theorist Ervin Laszlo, [44] mathematician C. J. S. Clarke, [45] and many other respected scholars. [46]

BENDING THE TRUTH

Take the case of 18-year-old Jesse Gelsinger of Tucson, Ariz, who was advised to undergo gene therapy at the University of Pennsylvania for a rare metabolic problem he had suffered since birth. Following the gene transfer in the fall of 1999, in which a type of adenovirus was used to carry genetic material into the cells of his liver, Jesse died. In a tearful testimony before a Senate committee in February, Paul Gelsinger, Jesse's father said, "We gave our consent, but in no way was it informed." [47]

The University of Pennsylvania responded immediately to Gelsinger's death. They voluntarily shut down the gene transfer trial and notified the Food and Drug Administration and the National Institutes of Health, which jointly regulate gene therapy trials. Looking further, the NTH discovered that many scientists performing the trials were not following the guidelines that gov­ern reporting of adverse events. They found that only 39 of 691 serious side effects experienced by patients, in studies using the technique that killed Gelsinger, had been immediately reported to the NIH. [48]

In the days following Gelsinger's death, other deaths and suffering in patients enrolled in gene therapy trials were made public. Four of 7 patients in a trial at Boston's Beth Israel Deaconess Medical Center had died in the summer of 1999. [48] And at St. Jude Children's Research Hospital in Memphis, the institutional review board suggested that researchers at that institution not tell 19 children and their parents that the gene transfer material used in a neuroblastoma trial might have been contaminated with HIV or hepatitis C. Once this information was about to be made public, the hospital changed its mind. [48]

Why are researchers reluctant to tell patients "the truth, the whole truth, and nothing but the truth"? Researchers seem to fear that if they reveal too much, patients will no longer volunteer for risky experiments. This is not the case. Paul Gelsinger, Jesse's father, said in his Senate subcommittee testimony that Jesse did­n't count on personally benefiting from the gene therapy, but he did it anyway, mostly to help other youngsters." Eric Kast, a 33 ­year-old man with cystic fibrosis, expressed a similar sentiment before the same Senate subcommittee, saying, "I am willing to make informed decisions and take those risks to contribute to better treatments and an eventual cure for cystic fibrosis." [48(p26)]

Every time researchers shade the truth or hide a fact, their sacred covenant with patients is damaged. Then, if things go wrong, science suffers along with the patient.

SELLING OUT

If you think science is neatly split between research in inde­pendent university labs and in companies that produce products for profit, you're about 20 years behind.... Sheldon Krimsky [of] Tufts University ... predicts that a private company will proba­My buy an entire university some day; in the meantime, it's one professor at a time.
- Tinker Ready [49]
"Science for Sale"

Trust and confidence are eroded when patients discover that researchers and clinicians have financial ties that could influence their decisions.

"[T]hanks to the triumph of the market and all its values in recent years, ... Americans have a new rite of passage: selling out," writes journalist Jeremiah Creedon. [50] What happens to sci­ence when scientists engage in this rite of passage? As an exam­ple, Creedon reports the case of Michael Phillips, a scientist who headed an important study of the safety of genetically engi­neered crops. In the summer of 1998 Phillips suddenly switched sides, accepting a job with a biotech trade group, which shocked the sponsor of the study, the National Academy of Sciences. Despite the obvious breach of ethics, the academy insisted that the results of the study would be objective. Not everybody believes them, including research watchdog Sheldon Krimsky, a professor of urban studies at Tufts University. "There's no ques­tion in any reasonable person's mind that who you get the fund­ing from affects your work," he says. [49(pp60-61)]

A survey of 2167 university scientists published in 1997 in The Journal of the American Medical Association found that 20% delayed publication of research for more than 6 months at least once during the preceding 3 years. [51] The reasons most frequently given were to allow time to negotiate a patent, to protect the pro­prietary value of the research, to slow the dissemination of nega­tive or undesired results, to protect their scientific lead, and to resolve disputes over intellectual property. Individuals involved in human genetic research were most likely to be secretive with experimental findings.

"Rare is the truly disinterested researcher," write journalists Kurt Eichenwald and Gina Kolata in the New York Times. [52] This is particularly true when physicians invent medical devices. Eichenwald and Kolata described how thousands of heart spe­cialists watched on closed-circuit television monitors at the Washington Convention Center in 1997 as a stent was implanted in the coronary artery of a patient in a distant hospital. They heard the voice of Dr Martin Leon, a prominent cardiologist, describe the operation as it was taking place. Dr Leon waxed enthusiastic as he described the stent's good qualities. What he did not tell the thousands of doctors who were watching was that he was an investor in the company that manufactured the device; and that after a merger of the company, announced that week, he would be among around 100 investors who stood to split as much as $75 million in stock, provided the company met certain business goals, including sales targets for the stent he so eagerly recommended.

He isn't alone. "If you are an interventional cardiologist and you are working hand in glove with the companies and you might have a financial tie, what else is new?" says cardiologist Dr David Hillis of the University of Texas Southwestern Medical Center. "If you have no conflict of interest, then you would stand out like a sore thumb." [52(pA1)]

"[F]inancial ties have transformed the traditional system of objective medical research and review," wrote Eichenwald and Kolata after their investigation. "Now, the system used to deter­mine which device is best for heart patients can be influenced as much by personal financial interests as by scientific data." [52(pA1)]

UNKINDNESS

Half of us are blind, few of us feel, and we are all deaf.
- Attributed to Sir William Osler (1903), on physicians

One of the main reasons people develop the science blues is physician insensitivity. On September 7, 1999, Manhattan obste­trician Allan Zarkin etched his 3-inch initials, AZ, into the skin of new mother Linda Gedz as she lay sedated in New York City's Beth Israel Medical Center following a cesarean section. [53] Zarkin said he did it because he had done such "a beautiful job." Gedz says she "feels like a branded animal," and is suing Zarkin for $5.5 million. Zarkin has been dubbed "Dr Zorro" by hospital staffers following the incident. He is being investigated by the Manhattan district attorney's office for 2 other alleged incidents of medical misconduct, and his license has been suspended pending the outcome of the investigation.

Most incidents of physician insensitivity are of course not this dramatic. More commonly, doctors simply forget that they are dealing with human beings and behave callously--as when the parents of a newborn baby, whose tests disclosed Down syndrome, were notified by their doctor of the diagnosis by voice mail. [54]

Another variety of insensitivity is bullying. Shelby Lonergan of Boone, Iowa, took her 2 1/2-year-old son Keaton to the University of Michigan Medical Center in Ann Arbor for complications from a birth defect, hypoplastic left heart syndrome. She said a doctor tried to pressure her and her husband to consent to a particular kind of surgery, even though it was certain her son would not sur­vive the operation. "He said, either we have to have the surgery or we have to go to another hospital," she said. "I felt that he wanted to use Keaton as an experiment." Ms Lonergan and her husband complained to other physicians, and Keaton was allowed to finish his treatment there and return home. [54]

C. Everett Koop, former US surgeon general, who lost a child, says that the lack of a bedside manner does not merely hurt people's feelings, but can also interfere with a patient's care. "If parents don't feel comfortable pursuing questions with the doctor, they don't learn what they need to know to care for their child," Koop said. Koop has commissioned the Take Time to Talk Advisory Council, whose goal is to improve doctor-patient communication."

A FALSE PICTURE

[C]asting science as the last word on everything from agricul­tural policy to academic appointments is fundamentally flawed, and likely to undermine the credibility of science with the public.
- Peter Brown [55]
Editor, The Sciences

The popular image of medicine as ultra-scientific is flat-out wrong. When people discover this, they get turned off.

"[M]uch, if not most, of contemporary medical practice still lacks a scientific foundation," writes David A. Grimes, MD, of the University of California-San Francisco School of Medicine. [56] Richard Smith, editor of the British Medical Journal, says that "only about 15% of medical interventions are support­ed by solid scientific evidence.... This is partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all." [57] And a 1978 Congressional Office of Technology Assessment report found that only an estimated 10% to 20% of the techniques that physicians use are empirically proven. [58] Sherwin B. Nuland, the Yale surgeon and author, states: "Unlike other areas in which fads come and go, medical styles [of prac­tice] are meant to be supported by irrefutable evidence. That assumption is so far off the mark that the term 'medical science' is practically an oxymoron." [59]

I had the opportunity last year of addressing the house staff of a large hospital about current developments in CAM. I suggested that, since most of what we do as physicians has not been empirically validated, there is room for looking outside of conventional medicine for therapies that might work. After my talk, a prominent staff physician strenuously objected to my comments. "How dare you say medicine isn't scientific!" she complained. "I'll send you papers and references to support my claim," I said. "After you've had a chance to read them, let's talk." She never responded to the information I sent. This expe­rience reminded me that many physicians are often unaware of the shaky foundation of medical science, and they don't like to be told otherwise.

TAKING RESPONSIBILITY

There is no cohesive effort to improve safety in health care.
- Institute of Medicine, National Academy of Sciences, 1999 [60]

Because aviation kills its customers in hatches, the airlines would never get away with such a haphazard performance.
- The Wall Street Journal, December 15, 1999 [61]

In late 1999, the Institute of Medicine of the National Academy of Sciences released its study of medical mistakes. The study estimated that the number of US patients who die annual­ly from medical errors ranges from 44000 to 98000. [62]

It's the nature of the system and not professional incompe­tence that's largely to blame. As Nuland [62] states:

Keeping complications to a minimum [in hospitalized patients] demands a delicately balanced coordination of mul­tiple influences, every one of which depends on decisions made by fallible human beings. The number of doctors and other professionals involved in the care of any patient in a hospital is so large that the attending physician often is unaware of who some of them are. A single patient in a single day may deal with a nephrologist, an infectious-disease spe­cialist, a pulmonologist, a cardiologist, a gastroenterologist, an "intensivist," and three or four members of the depart­ment of diagnostic imaging, each of whom is a super specialist in a different branch of that discipline. With so many steps and so many people involved in every aspect of care, the pos­sibilities for error multiply, and small lapses quickly escalate into major events and occasionally into tragedies. If ever there were an example of chaos theory in action, this is it.

The sad thing is that we've known about these problems for so long and have done little or nothing to correct them. Again Nuland [62]:

[D]octors have known about this ever-worsening situation since almost the beginning of the present era of burgeoning biotechnology. A 1956 article in the New England Journal of Medicine gave the name "diseases of medical practice" to untoward outcomes directly caused by seemingly appropri­ate medical care. In 1964 the Yale-New Haven Medical Center published the first analysis of such cases, using this criterion: "An episode was included in his analysis if it resulted from acceptable diagnostic or therapeutic mea­sures deliberately instituted in the hospital." The findings: "Deleterious episodes befell 20 percent of all patients admitted ... and were major in 4.7 percent." During the eight months of the study, there were 1,252 admissions and 240 such deleterious events, of which 16 ended up with the patient's death. This means that 1.3% of admissions to the university medical service--one of the best in the coun­try--resulted in death due to a complication traceable to some diagnostic or therapeutic procedure intended for the patient's benefit.

The study was published in Annals of Internal Medicine, a widely read specialty journal, under the thought-provoking title "The Hazards of Hospitalization." It did provoke a great deal of thought, and more than a little heat, but no demonstrable changes, either at Yale or elsewhere.

It's crucial to emphasize that the authors of these two articles were referring not to incompetence or negligence, but to problems that result from the work of skilled profes­sionals with the best of intentions.

I was recently on a national radio talk show devoted to the topic of CAM. A physician who is an aggressive debunker of this field was also a guest. Soon the discussion got around to the rela­tive side effects of the therapies under discussion. The debunker dwelled at length on how "herbs kill people" and how CAM "seduces people from using 'real' medicine," which he consid­ered a form of homicide. I suggested that he was using a double ­standard. The fatality rate of conventional therapies is so high, I pointed out, that had these deaths occurred in any other area they would be considered a national scandal. I mentioned the evidence [63] that more than 100000 people die each year in American hospitals from drug complications-the equivalent of a passenger airliner crashing every day. If the debunker was so concerned about peoples' health, why didn't he spend his energy preventing medical deaths instead of ranting about the occasion­al person who has a negative reaction to St. John's wort? The physician went ballistic and began screaming that the problems of conventional therapies "do not justify alternative medicine."

The reluctance of conventional medicine to own up to its dark side is shameful and scandalous. One of the major reasons medical science is viewed with ingratitude is that we have not come clean about the hazards of modern healthcare.

THE FUTURE

The best marriages, like the best lives, were both happy and unhappy. There was even a kind of necessary tension, a certain tautness between the partners that gave the marriage strength, like the tautness of a full sail. You went forward on it.
- Anne Morrow Lindbergh [64]

There you have it--a few of the reasons for my science blues.

Where do we go from here? How can doctors be encour­aged to remove their white coats and engage in the kind of dia­logue that might relieve their patients' blues as well as their own?

Einstein once said that we cannot solve the problems of the nuclear age with the same mode of thinking that produced it. just so, science cannot respond successfully to the public's rejec­tion by dwelling in the same mind set that contributed to the rejection in the first place. Another approach is required, a per­spective based not in cold logic and pointer readings but in the inner life of scientists themselves.

If I could produce just one change in medicine, it would not be a cure for cancer, heart disease, or AIDS, but a transforma­tion in doctors-opening up to that part of the psyche that is smothered in the process of becoming a physician (note 2). We must recover the wisdom we have collectively forgotten--how to harmonize intellect and intuition, reason and feeling--which makes it possible to connect with those we serve at a "heart level." Otherwise we will continue evoking resistance and antipathy from patients without knowing why, and feel unap­preciated and rejected in the process.

Charles T. Tart, [65] professor emeritus of psychology at the University of California, Davis, has long been interested in spiritu­ality and parapsychology. Over the years Tart found that scientists would open up to him about unusual experiences they'd had when they realized that he was a safe person to talk to. They would dis­close phenomena such as anomalous healings they'd witnessed, the sharing of thoughts at a distance, prophetic dreams they'd experienced, and so on. The scientists often told Tart that he was the first person to whom they had ever spoken about these mat­ters for fear of ridicule. This prompted Tart to open an Internet site called TASTE--The Archives of Scientists' Transcendent Experiences--where scientists can anonymously share personal experiences that are considered impossible in official circles.

The experiences posted on the TASTE Web site by physi­cians, mathematicians, biologists, and physicists are touching. These individuals honor science deeply--it's their life--but they are saying that science is limited because it has no place for these rich, meaningful events. Honoring these experiences is a way for scientists to connect with the majority of the culture that also experiences them. It is a way of sharing values and meaning with the rest of society. Unless scientists and physicians manage to do so, they will remain clueless that they themselves are a cause of the science blues, and they will continue to believe that an igno­rant, scientifically illiterate culture is solely to blame for the rift between science and society.

You can visit the TASTE Web site at http://psychology.ucdavis.edu/tart/taste. If this site is offline, you can use http://www.issc-taste.org.

Opening to the psyche's nonrational dimensions would lead to the fulfillment of science, not its ruin, as some critics charge. Many of the greatest scientists have realized this--for example, the 17th-century British chemist Robert Boyle, author of Boyle's law, who said that science is so sacred that scientists ought to do their experiments on Sundays as part of their Sabbath worship.

A change of heart in healthcare professionals: without it, the blues will endure on both sides--patients thinking doctors don't get it, and doctors convinced they're misunderstood.

TOGETHER AGAIN?

However often marriage is dissolved, it remains indissoluble. Real divorce, the divorce of heart and nerve and fiber, does not exist, since there is no divorce from memory.
- Virginia Peterson [66]

In spite of my science blues, I doubt that science and I will ever make a total break. There's simply too much history to ignore--too many good things that have happened in the past--and too many splendid possibilities for the future.

If we patch things up, however, I'll be wiser. I've learned that science is a jealous lover who insists on total devotion. She has tried to keep me home and that won't work any longer. I require freedom--the liberty to explore not just the peaks of the intel­lect, but also the depths of consciousness, no matter how messily irrational they may be.

The next step is up to her.

Larry Dossey, MD
Executive Editor

Notes

2. One of the best books about the transformation of physicians is From Doctor to Healer: The Transformative Journey [68] by medical anthropologist Robbie Davis ­Floyd, research fellow at the University of Texas at Austin, and healthcare consul­tant Gloria St. John.

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