Society for
Epidemiologic Research (SER) Presidential Addresses
1983:Paul Stolley
On Faith, Evidence, and The Epidemiologist, Winnepeg, Manitoba
Outgoing SER president and
University of Pennsylvania epidemiologist Paul Stolley delivered the
traditional departing address to more than 600 epidemiologists
assembled in Winnipeg, Manitoba for the 16th annual meeting of the
Society for Epidemiologic Research. Dr. Stolley argued for greater
reliance on the whole body of actual scientific evidence in settling
controversies and was critical of epidemiologists who criticize or
dismiss important epidemiologic findings because of real or imagined
minor flaws. Excerpts from his talk are presented below.
“...My brief talk today will be an attempt to sustain the modest
proposal that epidemiologists should persist in their efforts to
substitute evidence for faith in scientific controversy, to whatever
extent possible...
Pseudo-Science
A curious phenomenon has been
introduced into scientific controversy involving epidemiologists
during the last decade... I should call this phenomenon a variant of
pseudo-science; it is characterized by an inability or unwillingness
to synthesize available data coming from all fields that bear on the
problem at hand and instead placing extraordinary importance upon
small defects in study designs. Thus a convincing group of studies
might relate the toxic shock syndrome to the introduction and the use
of the highly absorbent tampons... Nevertheless, a group of
investigators, either acting independently or sometimes hired by the
company at risk, begin a kind of “witch-hunt” for alleged bias and
confounding in order to challenge the findings. Biases that may be
only postulated are somehow given a reality before their actual
existence is even demonstrated.
Social Responsibility
The charitable view of some of
the activities of so-called epidemiologists in this regard would be to
say that they are perhaps excessively iconoclastic...
That is not to say that all findings should not be scrutinized and
challenged, but this should be done with a sense of social
responsibility. There is a decided conceptual difference between
posing a test to challenge a hypothesis and applying the test. A
hypothesis does not fail a test just because it is speculated that it
will. A group of case-control studies, for example, are not invalid
because certain biases that might have occurred are postulated. It may
well be that some severe biases misled the investigator; but merely
raising these possibilities does not destroy the validity of the
study...
The Scientific Spirit
So it is clear that life is
becoming increasingly complex for epidemiologists. We will
increasingly be engaged in public controversy, will be working with
industry, and will be asked to participate in heated scientific
debates about risk or benefit.
It is hoped that the scientific spirit and a reliance on evidence will
guide us through the turbulent times we face. To quote the philosopher
Bertrand Russell, ‘the scientific state of mind is neither skeptical
or dogmatic. The skeptic holds that the truth is undiscoverable; while
the dogmatist holds that the truth is already discovered. The
scientist holds that the truth is discoverable though not yet
discovered (at any rate, not in the matters which are under
investigation). But even to say that the truth is discoverable is to
say rather more than the scientist believes, since he does not
conceive his discoveries as final and absolute. Absence of finality is
of the essence of the scientific spirit. In the welter of conflicting
fanaticisms, one of the few unifying forces is scientific
truthfulness, by which I mean the habit of basing our beliefs upon
observations and inferences as impersonal and as much divested of
local and temperamental bias as is possible for human beings!”
Published July 1983 vPostscript 2000
In 1983, I was concerned with
the problem of the “epidemiologist-for-hire” who thought it
professional and ethical to create the “best defense” for an indicted
product or risk exposure in the manner of a lawyer. This problem has
probably not improved as many recent examples can attest. My current
concern with our field is derived from the drastic changes we have
seen in university life so that sharing of data, openness and free
flow of scientific information is threatened by university/private
sector financial arrangements and the desire of the universities to
gain patent rights. This spills over onto epidemiology where creating
private businesses as a result of scientific discovery is glorified by
the euphemistic term “technology transfer” or “translational
research.”
The net result of this lamentable application of the business model to
the university is a stifling of data sharing and collaboration, free
exchange and an exaltation of priority of discovery and patentability.
The elevation of much of the scientifically deficient “alternative
medicine” has everything to do with money and little to do with
actually improving the health of the public. We now have medical
schools practicing homeopathy, endowing named chairs to
self-proclaimed guru/healers who use their own rules of evidence while
the school catalog prattles about its curriculum in “evidence-based
medicine.” I await with trepidation the first Division of Astrological
Healing. Sadly, much of this was predicted by the
sociologist/economist Thorstein Veblen in his 1919 book, The Higher
Learning in America.
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