On the sociology of medical meta-science: Exposing the Truth supports the Lie

By Denis G. Rancourt

A system, such as the medical establishment, based on lies and anchored in a profession is extraordinarily resilient -- in the case of medicine, even in the face of itself being the third leading cause of death [1].

How can this resilience be explained? What are the mechanisms that preserve professions from any independent thinking of their members?

With medicine, it is not just all the lies about effectiveness of treatments and of recommendations, but there is also the lie of what is not said: That by far the dominant determinant of an individual's health is the individual's position in the dominance hierarchy that he/she inhabits and that all other factors pale in comparison [2].

On the medical research side (something the US alone funds at the rate of $100 billion/year), a small group of dedicated so-called "meta-researchers" have pointed out what must be obvious to most clinicians and researchers with a brain, that most medical research findings are wrong. "80 percent of non-randomized studies (by far the most common type) turn out to be wrong", as do large fractions of both randomized and large randomized trials [3].

This was immediately apparent to me, as a non-medical scientist, when chemotherapy was recommended for a family member and I consulted the medical research literature about the recommended "treatment" -- that is, the comparative studies about the alleged benefits of the "treatment". Waaa.

In the present essay, I examine how it can be that the highly critical message of a meta-researcher such as Dr. John Ioannidis [3] can be so well received by the medical establishment on the one hand and so completely ineffective in causing any change in the medical establishment on the other hand.

Dr. Ioannidis provides an element of the answer himself: When asked why his message of the failure of medical research is so embraced by the profession, as measured by incomparable invitations to medical conferences and citation records of his published articles, he said "I think that people didn’t feel I was only trying to provoke them, because I showed that it was a community problem, instead of pointing fingers at individual examples of bad research" [3].

This leads me to re-state, yet again, my favorite truism about false social change: If you don't disturb anyone, in self-image or in societal status, then you cannot possibly be reforming anything.

But the analysis can be taken a significant step further. Dr. Ioannidis' professional peers, clinicians and researchers, crave to hear him describe his research results which show that most medical research on which medical practice is based is "misleading, exaggerated, and flat out wrong." [3] He is a top-draw at medical conferences -- they can't get enough of him.

This appears on first inspection to be a contradiction. So what is going on?

I think it's a peer-group phenomenon. Individuals in a given peer-group are perfectly comfortable adopting any behaviours, attitudes and positions -- such as dishonesty, theft, covert machinations, etc., which are not accepted in the broader societal self-image mythology -- as long as this is overtly recognized and approved within the peer-group, including a spoken or tacit recognition that the behaviours in question serve the interests of the members of the peer-group.

This is obvious and much of professional training involves developing the ideology and language that best conceals this gross truth about all professions [4]. For example, pick up a law textbook about the theory of lawyering under common law (a so-called "trial advocacy" textbook, say) and discover how in law there are "many truths" and how counsel must carefully select the particular truth that offers the best representation for the client, and that counsel is ethically bound to not lie... Quite stunning and the same is true of all professions.

A recent example involves university professors and the handy mythology of "academic freedom" [5], and illustrates yet another convenient compromise between the professional body of academics and management: [6].

A peer-group must comfort itself continuously in perpetrating its privileged-position-preserving assault on the broader society: From locker-room banter that "men are bastards" (haha) to lawyers in elevators joking about their purpose of "seeking justice" (haha), and so on.

As long as none of it gets personal, that the code is not broken, and that the Lie of the peer-group is supported to every peer-group member's benefit.

Well, the medical establishment, with its heavy mythology about saving lives, is in deep need of reparative peer-group banter. And what better banter then that from a meta-researcher explaining that from a statistical perspective -- without actually ever singling anyone out -- that from a statistical perspective most of what we take as known and most of what we do is wrong, haha, see the graph over here...

...Well now you know that the profession knows and that we meta-researchers are continuing to study this mother of all absurdities at the heart of our profession, and of course I only review the papers of other meta-researchers so do carry on and pay your association dues to invite more speakers...

It's perfect. The main Lie about actual objective value of the everyday acts of medical doctors, never mind the documented large-scale harm [1] and the unstated Truth [2], becomes the topic of comforting banter... that well, yes, it's what we do but we all do it and its the norm to just continue doing our individual best this way... It's the "practice"... the "standard recommendation"...

So drugs are approved as demonstrated-safe and then withdrawn because they are killers and organs are removed as standard treatment until the practice "evolves" and regular cancer tests are highly recommended until they are "discovered" to do more harm than good and AIDS is created into a human epidemic thanks to vaccination programs and fat is unhealthy until it is declared healthy and poison is good for you because when we stop the poison you think you feel better then before we started and indicator symptoms (like high blood pressure) can be removed with powerful drugs so you can die of the actual cause with the benefits of drug side effects and without ever knowing why and on and on.

My theory, therefore, is that Dr. Ioannidis is a provider of self-image-soothing locker-room banter for the medical profession. Only colleagues who will dare to point fingers have any chance of changing anything.

I'll take my chances with nature, thank you very much.


Endnotes

[1] For North American deaths; see the "Medicine is Health Lie" in "Some big lies of science" by Denis G. Rancourt, 2010, and references therein.

[2] See "Anti-smoking culture is harmful to health: On the truth problem of public health management" by Denis G. Rancourt, 2011, and references therein.

[3] See "Lies, Damned Lies, and Medical Science" by David H. Freedman, The Atlantic, 2010.

[4] "Disciplined Minds: A critical look at salaried professionals and the soul-battering system that shapes their lives" by Jeff Schmidt, 2000.

[5] "USA academic freedom scholarship as a measure of corporate fascism" by Denis G. Rancourt, 2011.

[6] "Wacko ATI ruling -- Ontario IPC uses academic freedom to restrict transparency" by Denis G. Rancourt, 2011.

Other essays by Denis G. Rancourt

Denis G. Rancourt is a former tenured and full professor of physics at the University of Ottawa in Canada. He practiced several areas of science (including physics and environmental science) which were funded by a national agency and ran an internationally recognized laboratory. He has published over 100 articles in leading scientific journals and several social commentary essays. He developed popular activism courses and was an outspoken critic of the university administration and a defender of student and Palestinian rights. He was fired for his dissidence in 2009. His dismissal case is in court hearings that will extend into 2012.