Doctors, Scientists, and the Scientific Establishment

I have been posting on social media about the COVID-19 pandemic, and I have encountered a series of misconceptions that people have about doctors, scientists, and the scientific establishment, so let me address them in this post.
 
Doctors and non-physician scientists have been trained in the methods and ways of science, so in that sense they are both scientists, but with one important distinction. The goal of doctors is to save and improve the lives of their patients, and that is even more so during the COVID-19 pandemic. However, the goal of scientists is to figure out what drugs and treatments actually work. Scientists need time to carry out research, but most doctors often don’t have time. The patient is sick NOW and may die, so what do we do? That is the question doctors have to answer in a hurry. When dealing with a disease that has many unknowns such as COVID-19, doctors often have to improvise. This is why doctors have (within reason) freedom to treat their patients as they see fit in consultation with them, although this freedom is regulated by the law, and may be restricted further if the doctor belongs an institution or organization that adheres to certain policies.
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While doctors and scientists understand that this freedom to deal with a patient’s illness is necessary, both doctors and scientists also understand that, barring some drug or treatment that is exceptionally effective, any treatments doctors come up with can only be validated by well-designed clinical trials. In fact, the majority of doctors will modify their treatments based on the results of clinical trials. Observational studies, where patients are sorted into treated and non-treated groups in a retrospective fashion, are highly prone to biases and cannot substitute for randomized trials. The authors of any such study will state as much when discussing the limitations of their study. This fact is widely accepted by the medical and scientific communities. However, when treating patients doctors deal with situations that often go beyond the mere effectiveness of a drug. For example, if a patient is strongly convinced that a worthless drug will help him or her, the doctor may choose to prescribe the drug anyway (if it is safe) just to exploit the placebo effect.
 
So next time you hear somebody not trained in science or even some doctors and some scientists say things such as, “Doctor’s know best.” or “We don’t need randomized trials.” or even “We don’t need any trials.”, remember that they represent a minority of all the doctors and scientists who know what works best and how.
 
Now let’s deal next with the scientific establishment.
 
The scientific establishment has been getting a bad rap lately. A series of individuals and groups have gone to the press and social media to claim that the scientific establishment has aligned itself with the interests of pharmaceutical companies to promote their expensive and dangerous drugs or vaccines while rejecting cheap alternatives like hydroxychloroquine (HCQ). They allege that the scientific establishment has known for more than a decade that HCQ works against viruses like the one that causes COVID-19. They allege that the scientific establishment was involved in designing the HCQ trials with high toxic doses on purpose so the negative results could be used against the drug. They allege that the scientific establishment was responsible for the publication of articles based on fraudulent data against HCQ in top journals to give the drug a bad name. And finally they allege that those who reject HCQ are complicit in the murder of tens of thousands of Americans!
 
I have addressed several aspects of these arguments before, so I will only do a brief recap here. The evidence for HCQ having activity against a virus similar to COVID-19 was very preliminary, and turned out to be misleading (see below). Of all the drugs submitted for approval to the FDA, only 14% are approved, and the same trial that found no effect of HCQ (the Recovery Trial) found an effect of steroids, which are cheap generic drugs. Why would this be the case if the scientific establishment is a puppet of big pharma? The HCQ trials were designed with those high doses to favor HCQ, which was considered to be a weak antiviral (now we know that HCQ has no antiviral activity against COVID-19). And those articles based on fraudulent data were retracted. Error was detected, addressed, and eliminated. This is how science should work.
 
I have not addressed the “thousands of deaths” argument before, so I will devote a few sentences to it. Someone honestly convinced about the effectiveness of a therapy and concerned about the lives of patients may use this argument sincerely. However, this argument is a double edged sword, because it is a common subterfuge employed by quacks as a form of emotional blackmail to get worthless therapies or products approved without scrutiny. Many doctors and scientists upon hearing this argument will immediately adopt an adversarial or at least unsympathetic position, because the assumption is that you don’t have the science that it takes to back your claims. So it is not a good idea to use it. When addressing the scientific establishment, you are better served using the common language of evidence, facts, and science.
 
The scientific establishment fulfills an important role in science. The scientific establishment is the keeper of the virtue of science. It protects science against fraud and error. It protects science against dangerous, unproven, or just merely stupid ideas. It protects science against the “unreasonable men”. The scientific establishment is conservative and sets a high bar for the acceptance of evidence. While the scientific establishment has made mistakes in rejecting ideas that were true (although sometimes rightfully so), the overall effect of the scientific establishment is a positive influence upon science.
 
But who or what is the scientific establishment? Critics of the scientific establishment tend to equate it with the leaders of scientific institutions who have the power. This is not true. While the scientific establishment has centers of power, it is made up of millions of voices, each contributing to the debate at different levels and vying to be heard. The scientific establishment is the combined effect of the scientific community. From those scientists who work in labs, to those who perform clinical trials. From those scientists who perform research to those who teach and communicate science to society. From those scientists who advise the heads of government, to those who criticize them, and those who criticize the critics. Although the scientific establishment contains a vast marketplace of ideas, it has a tried and true method to discern which ideas are true and which are not: the scientific method. And one of the things on which the vast majority of scientists agree is that they are unwilling to yield to any pressure that involves compromising this method.
 
Image from Pixabay by Peggy_Marco is in the public domain.