Among the reaction to my Atlantic article there has of course been a certain amount of skepticism and criticism. Some of the criticism has been perfectly fair and insightful, pointing out the ways in which I or Ioannidis (the physician-researcher I profile in the article who has documented and analyzed the high wrongness rate in medical research) might ourselves be biased, and might be spinning some aspects of the story. I touch on this problem in the article, and have a whole chapter on it in the book, and I have no interest in denying that my own bias and sloppiness (as well as those of the people I interview and those of my editors) may skew things.
I generally welcome criticism, and usually don’t respond to it–I figured I had my say–except as part of a formal response to comments submitted to the publication that ran the article. But I saw a blog post today that I think calls for a bit of a response. The post, by the physician-researcher David Gorski (whom I actually briefly quote in the Atlantic article), echoes posts in other blogs from a few people in or close to the medical community in essentially suggesting that the problems with research that Ioannidis has uncovered and that I report on in the article aren’t really big problems; rather, they’re just an acceptable part of the nature of research. I don’t think so. Bias and sloppiness may be routine and perhaps inevitable even among top researchers, but that doesn’t mean we shouldn’t be made aware of the extent of the problems and the toll it takes on the credibility of medical findings–and the vast majority of researchers seem to agree, to judge by most of what has been posted in response to the article. Gorski’s post also states that we should focus on the fact that (as I report in the article) 90 percent of large randomized controlled trials tend to hold up, and not pay much attention to the fact that other types of studies sink to levels as low 10 percent rightness and even lower. This is to me a shocking argument, considering that large RCTs make up a tiny percentage of the studies that fill journals, make headlines and influence treatment and lifestyle decisions.
Finally, the post argues that everyone should put their energy not into looking into the problems with mainstream medical research, but rather into the poor or non-existent science behind alternative medicine–and that we should keep our mouths shut about whatever problems we do find with mainstream medicine because it only gives ammunition to the alternative medicine crowd. Once again, I have to strongly disagree. People who are drawn to alternative medicine have already proven themselves essentially either uninterested in or incapable of assessing scientific evidence, and when researchers like Gorski rant and rave about alternative medicine they’re really just preaching to the choir, as is clear from the comments that appear under his post. In fact, compare the nearly unanimous point of view in these comments to those that appear almost anywhere else in response to the Atlantic article–Gorski’s fans clearly have their minds made up about people who criticize mainstream medical research, and they don’t even actually have to read the criticism themselves to feel comfortable commenting dismissively and authoritatively on it. Some of the comments, following Gorski’s lead, include ad hominem attacks on me that are based entirely on sloppy and mostly incorrect assumptions about my background.
Unlike the well-known absence (with a few exceptions) of good science behind alternative medicine, the serious problems with mainstream medical research have largely been unknown outside of the medical community itself. I believe the public has a right to hear about them, and to judge by the reaction the public seems quite interested in hearing about them. I quote Ioannidis in the article as pointing out that if mainstream medical science tries to keep quiet about its problems and limitations, then it is doing what it accuses alternative medicine of doing–misleading the public. I’m glad Gorski and his fans represent a small minority of the medical community in being unwilling to own up to and communicate these problems–see, for example, what the British Medical Journal had to say about my book–and in focusing instead on endlessly recycling the same old complaints about alternative medicine because it makes them look good in comparison.
And for the record: Along the way, Gorski belches out the sarcasm-and-bile-drenched claim that my earlier post on this blog relating to quack autism researcher Andrew Wakefield reflects my refusal to recognize that Wakefield was wrong. That’s just plain silly. The point of the post was that the outing of a rare, gross fraud like Wakefield distracts from the more widespread, routine problems in medical research trustworthiness. I think I was pretty clear about that, but judge for yourself. I happen to be a little sensitive to the suggestion that I support quack autism research, because two members of my immediate family work with children with autism, relying solely on the treatment that is the mainstream standard of care, applied behavior analysis. I know quite a bit about autism quackery, actually. I just didn’t think the intelligent readers of this blog needed me to rant and rave, Gorski-style, about an obvious and blatant charlatan who had long been making global headlines for his misdeeds. (And my Wakefield post linked to an article that described the misdeeds at length, though I just now changed the link to point to a similar article because the original is no longer online.) Considering that he passes himself off as the champion of objectivity, facts and reason, Gorski seems surprisingly comfortable distorting the facts to fit his nearly undisguised biases. But maybe we should be grateful for undisguised biases–it’s really the well-disguised ones we need to watch out for.