Through blogs and comments, patients and experts explore what it takes to find good health care and make the most of it.

Guest Blog: The Beautiful Uncertainty of Science


I am so tired of this all-or-nothing discussion about science! On the one hand there is a chorus singing praises to science and calling people who are skeptical of certain ideas unscientific idiots. On the other, with equal penchant for eminence-based thinking, are the masses convinced of conspiracies and nefarious motives of science and its perpetrators. And neither will stop and listen to the other side's objections, and neither will stop the name-calling. So, is it any wonder we are not getting any closer to the common ground? And if you are not a believer in the common ground, let me say that we are only getting farther away from the truth, if such a thing exists, by retreating further into our cognitive corners. These corners are comfortable places, with our comrades-in-arms sharing our, shall we say, passionate opinions. Yet this is not the way to get to a better understanding.

Because I spend so much time contemplating our larger understanding of science, the title "Are We Hard-Wired to Doubt Science" proved to be a really inflammatory way to suck me into thinking about everything I am interested in integrating: scientific method, science literacy and communication and brain science. The author, on the heels of doing a story on the opposition to smart meters in California, was led to try to understand why we are so quick to reject science:

But some very intelligent people I interviewed had little use for the existing (if sparse) science. How, in a rational society, does one understand those who reject science, a common touchstone of what is real and verifiable.
The absence of scientific evidence doesn't dissuade those who believe childhood vaccines are linked to autism, or those who believe their headaches, dizziness and other symptoms are caused by cellphones and smart meters. And the presence of large amounts of scientific evidence doesn't convince those who reject the idea that human activities are disrupting the climate.

She goes on to think about the different ways of perceiving risk, and how our brains play tricks on us by perpetuating our many cognitive biases. In essence, new data are unable to sway our opinion because of rescue bias, or our drive to preserve what we think we know to be true and to reject what our intuition tells us is false. If we follow this argument to its logical conclusion, it means that we just need to throw our hands up in the air and accept the status quo, whatever it is.

I happen to think that the author missed an opportunity to educate her readers about why we need to come to a better understanding and how to get there. The public (and even some of my fellow scientists) needs to understand what science is and, even more importantly, what it is not.

First, science is not dogma. Karl Popper had a very simple litmus test for scientific thinking: He asked how you would go about disproving a particular idea. If you think that the idea is above being disproved, then you are engaging in dogma and not science. The essence of scientific method is developing an hypothesis from either a systematically observed pattern or from a theoretical model. The hypothesis is necessarily formulated as the null, making the assumption of no association the departure point for proving the contrary. So, to "prove" that the association is present you need to rule out any other potential explanation for what may appear to be an association. For example, if thunder were always followed by rain, it might be easy to engage in the "post hoc ergo propter hoc" fallacy and conclude that thunder caused rain. But before this could become a scientific theory, you would have to show that there was no other explanation that would disprove this association.

So, the second point is that science is driven by postulating and then disproving the null hypotheses. By definition, an hypothesis can only be disproved if we 1). the association exists, and 2). the constellation of phenomena is not explained by something else. And here is the third and critical point, the point that produces equal parts frustration and inspiration to learn more: That "something else" as the explanation of a certain association is by definition informed only by what we know today. It is this very quality of knowledge production, the constancy of the pursuit, that lends the only certain property to science, the property of uncertainty. And our brains have a hard time holding and living with this uncertainty.

The tension between uncertainty and the need to make public policy has taken on a political life of its own. What started out as a modest storm of subversion of science by politics in the tobacco debate, has now escalated into a cyclone of everyday leveraging of the scientific uncertainties for political and economic gains. After all, how can we balance the accounting between the theoretical models predicting climate doom in the future and the robust current-day economic gains produced by the very pollution that feeds these models? How can we even conceive that our food production system, yielding more abundant and cheaper food than ever before, is driving the epidemic of obesity and the catastrophe of antimicrobial resistance? And because we are talking about science, and because, as that populist philosopher Yogi Berra famously quipped, "Predictions are hard, especially about the future," the uncertainty of our estimates overshadows the probability of their correctness. Yet by the time the future becomes present, we will be faced with potentially insurmountable challenges of a new world.

I have heard some scientists express reluctance about "coming clean" to the public about just how uncertain our knowledge is. Nonsense! What we need under the circumstances is greater transparency, public literacy and engagement. Science is not something that happens in the bastions of higher education or behind the thick walls of corporations. Science is all around and within us. And if you believe in God, you have to believe that God is a scientist, a tinkerer, always looking for a more elegant solution. The language of science that may seem daunting and obfuscatory. Yet do not be afraid -- patterns of a language are easy to decipher with some willingness and a dictionary. Our brains are attuned to the most beautiful explanations of the universe. Science is what provides them.

Self-determination is predicated upon knowledge and understanding. Abdicating our ability to understand the scientific method leaves us subject to political demagoguery. Don't be a puppet.' We are all born scientists. Embrace your curiosity, tune out the noise of those at the margins who are not willing to engage in a sensible dialogue, leave them to their schoolyard brawling. And likewise, leave the politicians, corporate interests, and, alas, many a journalist, and start learning the basics of scientific philosophy and thought. Allow the uncertainty of knowledge excite and delight you. You will not be disappointed.

More Blog Posts by Marya Zilberberg

author bio

Marya Zilberberg, MD, MPH, is a physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. She is the Founder and President of EviMed Research Group, LLC, a consultancy specializing in epidemiology, health services and outcomes research. She is also a professor of Epidemiology at the University of Massachusetts, Amherst. Dr. Zilberberg is a member of multiple journal editorial boards and is frequently invited to speak about evidence-based medicine, research methods and healthcare-associated complications. She blogs about healthcare at Healthcare, etc.

Tags for this article:
Evidence-Based Medicine   Marya Zilberberg   Seek Knowledge about your Health   Inside Healthcare  

Comments on this post
Please note: CFAH reserves the right to moderate all comments posted to the Prepared Patient® Blog. Any inappropriate postings will be removed.

Tweets that mention Prepared Patient Forum: Guest Blog: The Beautiful Uncertainty of Science « CFAH PPF Blog -- says
February 2, 2011 at 6:13 PM

[...] This post was mentioned on Twitter by Janice McCallum and Marya Zilberberg, elaine schattner. elaine schattner said: Thoughtful essay on science by @murzee, considers "tension" between uncertainty in data and need for public policy - [...]

johngreiss says
February 3, 2011 at 1:02 PM

The uncertainty of science is not so beautiful when physicians try to make informed decisions about the next thing that is best to do on behalf of a particular patient.

â??There is no science of the individual, and medicine suffers from a fundamental
contradiction: its practice deals with the individual while its theory grasps universals only.â?? (Temkin O. 1963. The scientific approach to disease: specific entity and individual sickness. In Scientific Change, ed. AC Crombie, pp. 629â??55. New York: Basic Books)

"This observation was made by observers of the past who saw that because there
was no science of the individual, there was noway to treat a patient as an individual.
It is not clear what they thought that science of the individual was, but we know
what it is today. It is the uniqueness of the individualâ??genetic, developmental,
and experientialâ??that accounts for human variation, whether in health or disease."
Childs, Wiener and Valle A SCIENCE OF THE INDIVIDUAL: Implications for a Medical School Curriculum. Annu. Rev. Genomics Hum. Genet. 2005. 6:313â??30

The complex interaction of genetic, developmental and experiential fores and factors makes it theoretically impossible to be certain how a particular patient with a specific diagnosis will respond to a given course of treatment. Patients may want certainty, but all medical science can do is offer its best guess. That is what science needs to be honest about.