From coronavirus to climate change, scientific discussion has been stifled by the ‘settled science’ trope. As a long-term analyst and careful critic of medical papers it annoys me. In 2000 I began a column in the journal of the British Society for Rheumatology (conveniently titled Rheumatology) trawling the journals for interesting, unusual or bizarre pieces of research, which I would dissect for my readers. Five years as a columnist honed my critical eye.
One cornerstone of medical research is the null hypothesis. You set up an idea and try to find something that knocks it down. A parallel concept is that of the Black Swan, where a plan is derailed by an unexpected event. In each case a single observation or fact which disposes of the hypothesis is sufficient for its abandonment. Bill Stott encapsulated this in a brilliant cartoon in Punch some years ago.
Various doctors have described how one of their teachers would tell them that, after five years, half the things they had been taught would be shown to be wrong, and the problem was that you didn’t know which half. But it underpins the argument that medicine – and by extension science – is not a static subject and is always subject to change. There are endless examples of how scientific consensus has been disrupted by a contrary observation which pulls the whole house down. Some are well-known, some less so. Here are a few. As you will see there are different mechanisms and causes.
Settled science said the Sun went round the Earth until Galileo and Copernicus made observations that proved it did not. Both were lone voices and suffered for their beliefs. Settled science said that cholera and puerperal sepsis were considered miasmic conditions until John Snow conducted a controlled trial proving the former was water-borne and Ignac Semmelweis conducted a similar one for the latter. Snow’s work took some time to become accepted, while Semmelweis’ work took longer, no doubt in part because of the way he presented it and attacked his disbelieving colleagues.
Before 1921, settled science did not know the cause of diabetes. Then Banting and Best discovered insulin, though Paulescu in Romania was the first. So settled science then began to understand that insulin lack caused diabetes. But then it became apparent that there were distinct types of diabetes and that insulin lack was not the only cause; insulin resistance could occur. Then it was found that insulin lack might be caused by an autoimmune reaction destroying the insulin-producing cells in the pancreas. Then the hormones glucagon and later leptin were discovered. Diabetes was no longer due to failure to produce insulin alone, and diabetes became as confused as it had been at the beginning of the 20th Century. No settled science here.
Some infections of unknown cause were found to be due to viruses – but it was not until it was possible to see these microbes that cause and effect could be adduced. Similarly, the understanding of inflammatory processes and the realisation that white blood cells held a key role in disease transformed rheumatology management, but, just as with diabetes, the exploration of the inflammatory response changed the science. It was not just white cells; these now were subdivided into T-cells, B-cells and macrophages, and then the T-cells got further divided into T-helper cells, T-suppressor cells and T-null cells, and then the inflammatory chemical cascade ran amok with the discovery of all sorts of interferons and interleukins, the number of which latter is unclear (search Google using “how many interleukins are there” and you will find varying estimates from 30 to over 60). I have sat through many lectures describing the inflammatory cascade and the slides become more complex by the week. In these examples, advances in science – here immunology, biochemistry and microscopy – were key to unravelling mysteries and taking down hypotheses.
In the 1970s some research pointed to the possibility that rheumatoid arthritis was triggered by infection with the infectious mononucleosis virus. This hypothesis was confirmed in a couple of laboratories, only to be knocked flat by the discovery that the original results were due to contamination. So, one may argue that the revelation of faulty research led to a change in understanding (or belief). Belief also caused patients with back pain to be put to bed, often in hospital and in spinal traction. After all, who could argue with the concept that such pain should be treated with rest? I didn’t; sometimes I had four or five back pain patients in my ward. We had always done it, we were taught to do it and so we went on doing it. It was settled science. But in fact no-one had done any research to compare bedrest against ambulant treatment and when they did – if ever there was a medical U-turn, that was it.
Settled science relies nowadays on clinical trials. But have these been properly conducted? In other words, is the conclusion justified? Was the sample size sufficient to prove the case? Was randomisation properly done? Have the correct statistical tests been used? Have confounders been accounted for? Have all the data been properly analysed? Were there any conflicts of interest that could have influenced the publication of results? Have the conclusions been fairly presented? Have the data been open to outside inspection? Statistical teaching in medicine is patchy and I certainly would not profess to be a statistics expert, but others are and I can rely on them.
There were numerous trials of anti-inflammatory drugs in the 1970s which had too small sample sizes, and several which concluded that drug A was similar in efficacy to drug B, although re-analysis merely proved that the trial had failed to show a difference, which is not the same. Many trials used the wrong statistical tests and were improperly randomised or excluded specific groups. Patient selection for trials? Benoxaprofen (Opren) was deemed safe but had never been tested in older people who, it transpired, metabolised it differently and in whom it was far from safe. Similarly a preparation of oral gold (for rheumatoid arthritis; injectable gold was the mainstay of therapy in the 1970s) had pharmacokinetic data showing two patterns of drug clearance judged by its half-life in the body, but the sample size was small. Only one patient showed the second pattern of delayed clearance – but this was 15% of the sample, yet the analysis ignored it. Extrapolate to a population and you can see the problem; as it turned out, the population did show such a dichotomy and the delayed clearers had a higher incidence of side-effects due to drug accumulation. Some trials excluded dropouts from analysis and thus failed to assess properly why subjects failed to complete the trial. Conflicts of interest? Some trials were and are conducted by drug companies or by researchers receiving large grants from them, and negative results are often concealed. Positive results are great, but when looking at the risk-benefit analysis it is important to compare like with like. Thus, if a statin trial shows a 50% reduction in cardiac risk, what is that a 50% reduction of? If the absolute risk is 5% then a 50% reduction drops the risk to 2.5%, which is not huge. Often the risk is presented in absolute terms and compared with the benefit in relative terms, which is scientifically dishonest. And all too often the raw data from such trials are not offered up for independent analysis, with the feeble excuse that it is commercially confidential. All of these unsettle settled science.
The explosion of genomics has led to the unravelling of numerous medical mysteries, in particular in hereditable disorders and inborn errors of metabolism. Fifty years ago this would have been unthinkable, but science progresses, we find out more things – and we find things that undermine current opinion, as Einstein did with gravity and new space telescopes have done with quasars, black holes and other studies of the universe. If we did not find those things and realise that science can change, we would still, perhaps, think the Earth was at the centre of the Universe.
In today’s context we have the twin issues of SARS-CoV-2 and climate change. In the first case we have been led to believe that settled science proves that lockdowns and masks work and that the virus was of natural origin. In each case unpicking of the data, some of it concealed for whatever reason, undermines all three conclusions. We were bamboozled into believing that settled science showed that there would be an explosion of deaths, failing to see that the conclusion was not based on facts but on prophecy. We were told that settled science proved that vaccines were safe and effective, but when doubters asked for the evidence, this was largely absent, and our belief that settled science had proved the safety of m-RNA vaccines was destroyed by analysis proving significant DNA contamination. There is a hypothetical risk to this, but that risk remains unquantified if indeed it exists at all, but it is unsettling to think there might be a significant risk. Would it not be safer to do some long-term studies before exposing a global population?
The debate on climate change has also relied on models, and settled science activists have brushed aside the GIGO axiom – garbage in, garbage out. They have also failed to quantify the relative contributions of fossil fuel burning, volcanic eruptions, solar storms and sunspot activity, changes in the Earth’s magnetic field, deforestation and water diversion and failed to understand the effect of urbanisation. In plunging headlong into the promotion of so-called renewable energy they have also fallen into another common trap – that of proclaiming the benefits while failing to analyse what could possibly go wrong. If, as I was told this week, five of 50 luxury cars of the same marque had to be returned to the saleroom for replacement of their batteries after less than two years, what are the costs both to purchaser and manufacturer? If spontaneous combustion risk causes insurance premiums for such vehicles to become unaffordable, what is the future, let alone the likelihood that demands on electricity supply will become unmanageable, so the cost of recharging goes up and also becomes unaffordable? And this set of risks excludes any analysis of whether the climate is really changing as dramatically as the prophets foretell, which factual evidence seems to contradict.
When sceptics raise all or any of these contradictions they are disparaged as vaccine deniers, climate change deniers and dangerous fanatics. If there is doubt, then say so. There is nothing wrong with saying you don’t know. While there are undoubtedly some proponents of wacky conspiracies lurking in the undergrowth, the huge majority of sceptics have merely analysed the data in a scientific way and unravelled the settled science consensus. And then the settled scientists themselves become deniers because they are too rigid to change their minds despite the revelation of incontrovertible facts.
These few examples lead to the inescapable conclusion that there is no such thing as ‘Settled Science’. Such science may be informed by dogma, belief, poor research, inadequate information and even fraud. New investigative techniques, re-analysis of past work, repeats of trials in the light of new knowledge all confirm that science may change. ‘Settled Science’ is an oxymoron. Let’s leave it behind.
Dr. Andrew Bamji is a retired Consultant Rheumatologist and author of Mad Medicine: Myths, Maxims and Mayhem in the National Health Service.
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86% of those who took part voted for left wing parties. 14% voted Reform. Anyone who is still voting Tory is either not a conservative or hopelessly deluded.
Then there is the Harrogate Agenda, and whatever else. In 2022 the government’s behavioural scientists discovered that the people were more pliable than they expected – like sheep. I fear that campaigns like this are not only a waste of time but give a false impression that something can be done. It says, ‘Don’t vote!’ but many did not vote. Are things better as a result? If we want better government we will need a better populace.
Anyone who supports the idea of “Not in my name” basically supports the idea of. smaller state.
Some of them know it, and some of them just haven’t realised it yet.
The latter have yet to discover that you can’t rely on getting wise, intelligent, selfless leaders. You might miraculously get one from time to time, for a bit. But as a general rule you will get self-serving midwit grifters. So the only solution is to shrink the state and have absolute minimal need for political leaders.
Indeed. Sadly none of the mainstream parties are standing on that platform – turkeys not voting for Christmas.
This solution started out with Maggie Thatcher. And after 45 years of shrinking the state in a row, it’s widely acknowledged that all the remaining public and privatized services have become both massively worse and massively more expensive and Deadweight Ed and Chaos Keir are in the process of selling our bodies and souls to an international cartel of “green technology” billionaires and pharma companies, we being the last commodity the state controls which hasn’t been privatized yet.
Shrinking the state has proven to be a massive, f***ing disaster and more of it won’t help, in the same way more COVID boosters won’t suddenly lead to Zero COVID wonderland.
Shrinking the state is not just about privatisation, which has been only a partial success, but about reducing the involvement of the state in our lives. We have too many laws and regulations. I think the state should get out of healthcare and education.
Shrinking the state is not just about privatisation, which has been only a partial success, but about reducing the involvement of the state in our lives. We have too many laws and regulations. I think the state should get out of healthcare and education.
When it’s not about privatisation, why aren’t you calling for anything specific except more privatisation? A lesson which should have been learnt from COVID is that so-called private entities are much freer wrt to discriminating against customers they don’t like for any reaons than the state.
Privatizing the NHS in its present state will lead to the exact NHS we have, just free from any requirements of fair and equal treatement outside of discrimination because of protected characteristics named in the Equality Act. In extremely simplified form, this will mean no more hip replacement or cataract surgery for smokers because “it’s not cost effective” as they’re going to die too early to profit from it, anyway. And this will extend to all so-called “elective procedures” of today: The same kind of would-politicans while then be able to use them absolutely freely to further whatever political goals they happen to have.
Banks are supposedly private. Yet. people get debanked for undesirable political opinions and their only redress is — public oversight which still sort-of works in this sector. When it comes to ‘funky injections’, the regulator has been completely privatized, ie, its bills are paid by the pharmaceutical industry and hence, the presently most profitbable product will invariably become the safest, effectivest and most required one.
One can argue that the NHS is broken by design and should be replaced with a different kind of healthcare system. But be that as it may, the present mess needs to be fixed first. Simply throwing it over a fence so that Virgin, Black Rock, Pfizer, Astra-Zeneca and all the other usual suspects can pick up whatever parts of it they like is not going to improve things.
There’s nothing stopping the state providing health insurance cover for uninsured/uninsurable people.
Discrimination is a tricky one – in theory the market should provide alternatives if there is demand, but if barriers to entry are high and a cartel of providers all behave in the same way for various reasons then it doesn’t work so well. Arguably a lot of the behaviour of private providers is a result of political/regulatory pressure.
The market should provide alternatives because it’s assumed that people operating companies have to care about their customers in order to make money. However, a large company which is profitable can always afford to piss off some minority of its customers. Economies of scale favour oligopolies and people working for a company that’s part of an oligopoly have no particular reason to care for the demands of individual customers as something like “annual revenue is £500 less than what it could have been” simply won’t figure on the balance sheet.
Case in point: I need a new harddisk because one of the two I have is dying. I ordered one from a company named Box (box.co.uk) a fortnight ago which advertises “Free next day delivery” on its website. Reportedly, the item got passed to DHL and then returned for a reason I don’t know. Nobody bothered to tell me about this, because “Why bother?” — this is a £55 transaction really nobody cares about.
The present state is that the company took my money but the people working for it won’t ship the item. I can probably get my money back but – in addition to the waste of time – that’s not going to help me. Granted, I can probably buy the item elsewhere but only as sort-of an act of mercy, ie, due to good luck, manageing to find some people who are willing to ship it, maybe because a throw of the dice went in my favour. That’s an absolutely typical “market performance” I’ve already plentifully encountered elsewhere.
The myth that private companies care for their customers because “competition” forces them to is simply wrong. And hence, the myth that anything can be improved by making it private is, too.
I certainly agree that privatisation doesn’t inevitably lead to better service, but I think its hard for the state to perform BETTER than a private firm because the incentives are trickier to put in place.
This gets me back to the German proverb Der Fisch stinkt vom Kopfe her — The fish stinks from the head. Incentives are really a matter of organization culture and work ethic and that’s ultimatively a matter of what leadership demands and is willing to impose onto itself. The people who were legally partying in Downing Street while the rest of the country was under lockdown attract followers like themselves. Every borough council probably had its own lockdown parties.
People don’t magically become shit just because they’re working for the state and they don’t magically turn into high performers seeking to fullfill their duties to the utmost just because they’re paid by some internet merchant company. It’s by-and-large the same kind of people who are working for public and for private organizations and this mens that, by-and-large, their performance will be identical.
To continue the story from above for illustration: It seems that the company supposed to ship the disk handed it over to DHL. DHL apparently never even made an attempt to deliver but just returned it to the sender. Maybe an error on their part, I don’t know. I’ve had an extensive live chat with some of the customer support guys in the vain attempt to get a disk delivered to me. But I could as well have been talking to a wall. Status of the item was “returning”, script for returning said “apologize to customer and promise refund once the item has returned”. Hence, that was all of the reply I could get from this guy, no matter how often I told him that I didn’t ask for this item to be returned and didn’t want a refund but a disk I had paid for. When I started to become insistent, I got an additional reply “No, we can’t ship out returned items again. We apologize … bla bla bla … wait for your refund”.
It’s hard to imagine that even the most aloof civil servant could have been more intransigent and less interested in whether his employer will end up making a profit or a loss here.
I agree that individuals and their approach to work are very important and make a big difference and that there is a mixture everywhere. But I am sure financial and other incentives (threat of losing your job) do also make a difference. Another issue is staff retention. A friend of mine is a young, very bright and hard working civil servant – exactly the kind of person the civil service should be trying to retain. But he is most likely going to work in the private sector because the money is much better and he has much better leverage there – he wants more flexible working arrangements but there is no flexibility on offer, despite his high value to the department he works for.
Many in the establishment probably regard Parties of that kind as a virus. From their position, they welcome the first past the post system, which offers quite high immunity from infection. Even if you look at the devolved countries (Scotland and Wales) which have partially proportionate systems, it won’t be easy to move away from FPTP.
The idea that MPs should be people from their constituencies elected because of themselves and not because they were running on some party ticked is IMHO principally sound.
Indeed. My MP says he will represent ALL of his constituents but how can he – he was elected on a party platform and will be whipped to vote with his party? He doesn’t represent me.
Apropos your comment a bunch of vain inadequates, who – at present have control over us, but no moral, ethical or logical authority to rule https://www.hughwillbourn.com/post/54-madness-and-the-evaporation-of-authority
However. 13 million people voted leftist (Labour communists and Lib Dum Marxists) and only 10 million voted right ish – Tory and Reform.
Britain could be argued to be a failing, left wing nation. We are done for if those figures keep happening.
The Tories are not right wing – just less left wing than the other Uniparty parties.
We need more direct democracy like Switzerland. We should decide on major issues by referendum.
And, a proportional voting system that had transferable votes in the second round. I suspect that would push voters to really be careful about who they wanted to take power. I suspect that if voters had had that choice at the last GE, there may have been a different outcome.
Has ‘notinmyname’ looked at all possible political systems and worked out which system will work best, both from a representative and pragmatic angle?
I would like to see it.
Is there a merit to start a political party with it’s only remit to change the electoral system to the new system and once that has been achieved to bow out and call new elections based on the new system?
If we want the current political class to change the system it won’t happen. It is not in their interest.