The Scientific Method and Tempus Clinic; building your own biological model of your health
The reason I make what may seem like almost a fetish of ‘the scientific method’ is that we have all suffered from failing to understand it and by other’s abuse of it. I want to give you a tool with which to defend yourself from its misuse.
The scientific method is a historically proven model to discover the details of the physical reality that both surrounds us and is knowable by the senses. It is never value free, it is never permanently and immutably grounded in an unchangeable reality. It is in fact more like the machines that lay railroad track; they create the very path they are riding on. They lay the track as they go. The same is true of science; it starts somewhere incapable of knowing exactly where it is going but knowing that it must start somewhere and be laying track, making progress in a process that grows from where it starts.
Ourscientific understanding is always being refined and in fact completely reformulated as we discover the dead ends that our first line of thought, of track, has led to. The astronomy of Ptolemy gave way to that of Galileo which gave way to that of Newton which gave way to that of Einstein and general relativity. The world hadn’t changed, the stars hadn’t changed, but our understanding of the forces that govern them did. The change was always in response to more information, never less, and a deeper understanding of the greater complexity of the subject under scrutiny. I will want to come back to this issue of greater complexity leading to different models of describing the subject of scientific and speculative thought.
This same process of changes in models of understanding applies to biological systems as well. Unfortunately in the application of biological models to the real world of medical practice by the time the change in model has been adopted by medical practitioners many people have suffered and died. Simple examples abound. While the starting point of understanding is always inadequate it is capable of improvement; that is the beauty of the scientific method. The problem is that it always yields a successive number of approximations; as each attempt at understanding works its way to its conclusion, the end of the self-laid track, it must reorient itself to reflect the understanding the new dead end reveals. Can’t go over that mountain; may need to go around it. Newton doesn’t quite explain why there are perturbations in the orbits of some planets (this is an interesting historical component of the search that led to general relativity but, after all, not really relevant to that search) then something else needs to change; Einstein provides one solution. There are in fact others but this is not important for us here. They had to move the tracks, find another route to the understanding that the prior stage of understanding came to and which was then found inadequate to the data then seen.
The science of biological systems is still very crude and began in an even cruder place. Mankind wanted to know how the human body worked and started its modern quest with little information beyond the broadly conceptual work of the ancient Greeks, Egyptians and Chinese and the accreted folk wisdom of how to use leeches, herbs, Shamen and other culture based healers. Astronomical systems are so much less complex than biological systems that cultures which had very sophisticated models of the movement of planets and stars had little more than superstition to guide their theories of illnesses and their cure.
I want to impress you with, demonstrate to you, the relative crudeness of contemporary understanding of biological systems in order for you to see how value loaded its process is and thus help arm you against being seduced by some of its claims which stem from its unacknowledged inadequacies.
One of the hallmarks of the scientific method is its ability to generate an hypothesis from within the rules of the theory being queried, to then test that hypothesis, and depending on the outcome either show that the hypothesis was correct and reflected an adequate theory or that at the very least the hypothesis was wrong or, and this must be an admitted outcome, or that the theory is wrong.
Let me get you oriented here. I’ll jump to current examples of a failed or inadequate scientific model applied to your health. There was some early work that showed that people with high blood pressure tended to have more strokes, heart attacks and kidney failure. So a hypothesis was generated, and took on a life of its own, that said lower blood pressure would lead to fewer strokes, heart attacks and less kidney failure. The epidemiology of populations showed that lower blood pressures were seen in people who had fewer strokes. Therefore, the reasoning went, that people with higher pressures would have fewer strokes if their blood pressure could be lowered. Notice something missing, something we all now know to consider: association is not causation. Everything that is associated does not mean that the one causes the other. And sure enough, recent work has shown that for a broad class of people we have been over-treating blood pressure to lower and lower numbers with dire health consequences. And some of those consequences, there are others, are almost predictable; some of the elderly have impaired memory and intelligence when treated to lower pressures; a slightly greater number of strokes but a clearly diminished quality of life. And then there is the issue of the toxicity of medications not clearly being considered in the trade off of risk and benefit. I will get to this in greater detail as it nicely illustrates how more information should broaden the theoretical model used to develop hypotheses about how the body works. Another association/causation mistake is seen in the rush, I was in that rush, to use folic acid (B-9), B-6 and B-12 to lower homocysteine; a known risk factor for cardiovascular and neurovascular disease. Those 3 B vitamins lower homocysteine very nicely. They also happen to cause kidney disease- long story how this problem was found among those with kidney disease and that it increased their stroke and heart attack rates- and stroke and heart attack risk in those with normal kidney function. Oh, and it increases the incidence of some cancers. Not quite what was intended when treating homocysteine with B vitamins.
OK, I don’t want to get too far into this at this point but note how broadly known the injunction ‘association is not causation’ happens to be, but I will tell you with many examples should you doubt it, that this simple rule is often at the very heart of the misuse of medication and supplements that plague us all. Drugs that help one thing cause another. Yet, in the naïve unfolding of biological discovery, when it was found that drugs that block adrenaline also lowered blood pressure such drugs were immediately incorporated into blood pressure management. Now if you had quoted ‘association is not causation’ to the clinicians who did this they would have agreed; who would not. But the reality is that their model of biological systems simply did not anticipate serious consequences. Their model did not contemplate the actual complexity of biological system’s interconnectedness. They plunged ahead. Did such an approach do more good than harm? I must tell you I think this is an unanswerable question. If you focus on a narrow range of problems, for example malignant hypertension- extremely high blood pressure- you will see dramatic results in probable lives saved. When the drug is broadly used within populations my guess is that its net effect has been to do more harm than good. When precisely used this is a wonderful class of drugs; the hypothesis that drugs that lower blood pressure can help is true within narrow limits.
And this is the primary failure of the current biological/medical theoretical model; it simple believes it knows more than in fact it does. The current model is riven with hubris as are all broadly accepted, older theories of anything. Once the cracks in a theory begin to show, humility follows shortly on the heels of embarrassment. Drugs to lower cholesterol cause memory loss, decreased testosterone, increase the risk of diabetes, impair healing rates in injury and other unpleasant things. It simply will not do to say ‘yes, but it lowers the risk of heart attacks!’ So will a daily handful of peanuts without all the bother and side effects.
What allows so many to agree to take a drug which might damage their liver and impair their sex life? Well, frankly a fear sold them by practitioners of a failed scientific model is the simple answer. A proper humility married to a driving curiosity would admit the obvious; total cholesterol has almost no correlation to vascular disease risk and a drug with a panoply of side effects used ostensibly to lower a number that doesn’t matter just isn’t a great idea. (The Swiss have high cholesterol and low vascular disease, Russians have low cholesterol and high vascular disease rates) Now that drug does something; sometimes a useful thing but lowering cholesterol, which it does, is not it.
How do we fix this? Are those who prescribe drugs that do more harm than good evil people?
Well there is a way to fix this and those who prescribe such drugs are doing their best to follow ‘evidence based’ medicine and to care for their patients.
To fix this mess requires at least one thing: go back to my model of the track laying machine that starts somewhere and goes somewhere and then meets a dead end that requires a kind of starting over. Remember I said science isn’t value free; here is where that particular rubber meets the metaphorical road; the current medical theory model is loaded with the value assumption that people will not take care of themselves. Won’t if bribed, threatened, informed or tricked. People are such ignorant, incompetent sheep that they will eat themselves into a stupor, become so lazy as to become sessile and are doomed to premature death and disease without the quick fixes of drugs that apparently kill fewer people than they save. Now that was a nasty sentence. But it is true. The statement for public consumption can be stated in a more diplomatic manner but, in broad outline, it is true nonetheless. Such an idea of mankind under-girds the audacity of those who investigate, discover, patent, market and sell most drugs for most chronic diseases.
Only if the current model assumed that disease was inevitable and self-correction was futile and that the culture accepted this value as true would we as consumers take drugs that make us tired, impotent and increased our risk for diabetes and cancer. This is an uncomfortable story but I think it is largely true.
The model needs to change, the values that shape our scientific understanding need to shift.
If the simple, true facts that almost all medications used to treat common chronic diseases like coronary artery disease, high blood pressure and diabetes caused cancers, fatigue, impotence, impaired sleep, fat weight gain, and increased your chance of fractures and depression if those facts were widely known, accepted as part of the true risk and benefit equation employed in determining the value of the medications and further that people understood that behavioral changes trumped all medication effects then both the scientist in his quest for cures and the patient in his desire for health would be using a more complex model of scientific inquiry and what counts as the fruit of that inquiry. For, in this case strictly, less so in astrophysics for example, our values fairly play a role in the nature of inquiry and what constitutes truth.
The observed and the observer are always changed in any investigation or inquiry of nature, of the world. Our current model, make something that comes in a pill that changes something associated with a disease, has changed the observer; it has changed the nature of mankind. It has changed him from an active agent in the world, recruiting his wonderful mechanism of self-healing, the body, to be healthier into a passive victim of the lethal compound of sloth, gluttony, bad pharmacy and hopelessness.
Far too little research has been done into the complexities of movement, exercise, active and passive rest, different food types, meal timing and social consequences on health and disease risk. Once it is recognized that exercise, the movement and recruitment of our complex musculoskeletal and neuroendocrine systems are as rich in possibilities of cure and change as is any pharmaceutical model this kind of whole body synergistic information will become as sought after as the newest ‘blood pressure medicine.’
The current medical model has barely gotten past the distinction between aerobics and resistance when any good old musclehead in any gym knows the possibilities of effect from different exercise types is many times more subtle than such a trivial, and wrong, distinction. We will get to this as well, by the way.
For now, to lay out the grounds for the research model of Tempus Clinic, let it suffice that, I believe, the correct medical scientific research model is one that recognizes that the interior self is more complex, by many orders of magnitude, than our current models contemplate and that the external world intervenes, intrudes on that inner complexity by so many devices, modes of action and interaction; that the inner and outer world are complex beyond our current understanding in such a way that only understanding the interface between that inner and outer complexity will yield meaningful changes in our life expectancy and the quality of our lives lived. That interface has a name: the will. The will is the interface between the inner complexity and the outer complexity and shapes the nature of the net effect of that interaction. I am not talking about motivation, another important concept or thing in the world, but that moment of choosing that entails picking something up, eating something, sleeping or taking a nap. The will defines the interactive complexity of the inner and outer world.
The reason I drag you through all of this is that my doc’s experience, gleaned from decades in the medical trenches, has taught me that most patients innately, reflexively trust their docs. What a wonderful thing. What a glorious testament to my profession. The problem is not with my peers in medicine or even Big Phama, as the conspiracy theorists like to call the pharmaceutical industry, but with a society-wide and centuries-deep, now near superstitious, belief that whatever the doc prescribes is better than anything else and surely better than spandex and dying while running a la Jim Fixx. It is almost a cartoon: take this pill, sure it might kill you, or die miserable, sweaty and bruised from the face plant when your heart stopped running up the hill.
Almost unrecognized by most physicians is that what we do on a day-to-day basis in not science. And this is more true than is covered by the oft quoted “medicine is an art and not a science.”
Until you dig into the difference between science as a physicist practices it and a biologist practices it and further between those two and the way medicine attempts to practice it; until you do this you will not see the boundaries between something close to knowledge and the reality of the culture of medical practice as it is practiced on you by your doc.
The medical model is a strange blend between politics- what insurance companies will pay for- institutional interests- yes it is true that MRI’s are ordered more by those who own them or see some kind of self interest in their use; might even be a good thing- and industry- of course pharmaceutical representatives shape physician prescribing practices- and, here is the scary part, by the biases and predispositions of the medical school elites. Let me illustrate the latter point: every doc can quote the claim that statins, Lipitor and the like, ‘reduce cardiovascular events by 30%. What few know or at least incorporate into their practice is the fact that there are many different ways to reduce cardiovascular events ‘by 30%.” Eat more peanuts, increase your level of fitness by one or two METS, change your diet in such a way as to lower insulin or inflammation; there are others. Our docs tell us to lower our cholesterol, almost impossible and not meaningful anyway, or we need to go on statins. ‘Get more exercise’ is another favorite. Still you will never hear “if you get more exercise and change your diet in this particular way, you will have lowered your risk by more than the known effect of statins and further that it is of help to almost everyone and not just the one or two out of hundreds benefited by statins.’
The reason you will never hear such advice is that the medical model of science never contemplates anything other than a drug solution. All medical journals will report the benefits of peanuts or exercise but they will never incorporate them into the same kind of metric or benchmark in which sets the statistics they will quote you for statins or blood pressure medicines or those for adult onset diabetes.
Biological science is more like observational astronomy than theoretical physics; it is in the business of describing things and not really discovering things. This confusion leads biologists and medical scientists to misunderstand the nature of their data. Description can lead to understanding but it is not the same thing. Noting the mass of the Sun and the Earth and the distance between them and the trajectory that relates them leads you to understand gravity but it is not the same thing as the inverse square law or even speculation about gravitons.
Tempus was designed to be an environment where each patient, client, customer- I never really settled on what to call them, these people who almost uniformly became my friends- where everyone could discover their own biological model of wellness or health or remission of disease and discomfort.
I knew that knowing your blood pressure when sitting in a doctor’s office had little to no real relationship to the broad statistic that higher blood pressure was related to your risk of stroke or heart disease or dementia. But what to do? I knew that an individual’s total cholesterol had almost no predictive power of that individual’s chance of dying of a heart attack. But what to do?
(By the way, I will get to why I knew these things in a minute; the short answer is I carefully read the medical literature)….
I’ll be back….
Smile, Have Fun, God Speed,
Dr. Mike
