April 25, 2006

Missing The Point At The NY Times

This time by one of our own (academic psychologist, Harvard) in an Op-Ed, entitled, "I'm Ok, You're Biased."


The premise is summarized here:

Doctors scoff at the notion that gifts from a pharmaceutical company could motivate them to prescribe that company's drugs, and Supreme Court justices are confident that their legal opinions are not influenced by their financial stake in a defendant's business, or by their child's employment at a petitioner's firm. Vice President Dick Cheney is famously contemptuous of those who suggest that his former company received special consideration for government contracts.


Which would be an ok, if not tired, set up, except for the very next sentence:

Voters, citizens, patients and taxpayers can barely keep a straight face. 

It's the populism of the message that is laughable.  So doctors, lawyers, Supreme Court Justices and others have no idea that they're biased, but the average joe does?  Seems pretty unlikely.  But-- maybe they are biased and it's okay.

And the proposed solution, of course, is the same knee jerk ineffectual nonsense proposed before:

In short, doctors, judges, consultants and vice presidents strive for truth more often than we realize, and miss that mark more often than they realize. Because the brain cannot see itself fooling itself, the only reliable method for avoiding bias is to avoid the situations that produce it.


There's that determinism so popular among those who feel powerless. 

I hope that the irony of the NY Times, through a psychologist, preaching about objectivity is not lost on anyone.  It is so bad at that paper that both the right and the left simultaneously blast it for overt bias.  No wonder that the NY Times stock has lost 50% of its value in two years.

Why not discuss the bias of journalists?  Or, more importantly, why are they assumed immune from it?  This isn't an idle political question, it is the very essence of this debate.

I'll state it explicitly:  first, the reason it doesn't matter if doctors are biased (and why it matters very much if journalists are) is because medicine is supposed to be a science. If it is a science-- receptors and all-- then it shouldn't matter what I think, it should matter what is true.  I can delude myself and say that seizure drugs are mood stabilizers for the long term; but that doesn't make it true.  But if you want to actually see if it is true, you have to look it up.  And don't come back with "one negative study doesn't disprove its efficacy."  This is science again: it's not up to me to disprove its efficacy, it's up to you to prove it has any.

So the real question isn't bias, it's whether medicine in general is paying attention to its own data.  Do we read our own studies, or hope the "thought leaders" will, and then write us a synopsis?  Do we believe it because Harvard said so? Is this science, or a cult of personality?


Second, when discussing medicine, the question of bias is not the important one. Yyou have to ask what the harm is.  Thie bias isn't harmful to science because science should be able to stand on its own.  The bias is only harmful to patients-- so the real question we should be asking is not if there is bias, but if it harms patients.  Ready: pretend a family doc gets paid $800,000 by Pfizer to prescribe only Lipitor, no Zocor, Mevacor, etc.  What, exactly, is the harm?  It's not snake oil: in all the anti-pharma controversy, no one is accusing them of selling a product that doesn't do what they say it does.  So unless you can tell me which patient shouldn't get Lipitor, but should get Zocor, then you can't argue this hurts the patient.  I'm not saying it isn't sneaky, or unethical.  But unless you can show the harm, you can't say it's harmful.  That's what's relevant.


But we're not really worried about patients, are we?  That's a screen.  What this is all about is our own impotence; anger against people who are perceived to have power.  We don't even actually believe our own nonsense.  This is the same argument against Vice President Cheney.  If everyone is so sure that the Iraq war was about oil and Halliburton, why didn't everyone buy Exxon and Halliburton stock back in 2002?  It's fun to criticise, I know.  But belief without follow through is pointless.  If you're not willing to act on your own beliefs, why should anyone else even listen to your crazy beliefs?


I'm not saying doctors and politicians aren't biased.  I'm saying we should worry about the things that actually matter.  Want to start somewhere, Daniel Gilbert? Academic medicine, and the journals that are their propaganda arms.  These people aren't scientists, they are science journalists.  And they are very much biased. Don't believe me?   Call me when you look up everyone's supporting references.