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How to make God laugh--tell Him about your future plans
- BM Hegde (6 May 2005)
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Mendelian randomisation is a good framework for controlling confounding
- Anthony Lwegaba (9 May 2005)
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BM Hegde, Retired Vice Chancellor Mangalore-575 004, India
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Dear Editor, Woody Allan poetically pointed out the fallacy in our predictions as above. Prof. WJ Firth, in his excellent article in the 1991 Xmas issue of the BMJ, very rightly pointed out how the present science of linear laws in a non-linear system (Human body) predicts the unpredictable.(1) All that we do in our present research methodology is to eliminate chance in the final outcomes, but it is CHANCE alone that comes back at the end of the day. “Work and acquire, and you have chained the wheel of chance”, wrote Ralph Waldo Emerson. Let us work to find out how to really eliminate chance in research sans statistics. “The ordinary man finds good or evil outside himself……But the thinking man finds them within himself,” wrote Anton Chekhov in his Ward 6 and other stories. Why not we find out where we have gone wrong for a change instead of finding devious statistical methods to prove the impossible? It has been decades since I had been repeatedly pointing out the fallacy in our research methods, using the linear laws of deterministic predictability. No body seems to care! While we are excited about nano- technology (for there is money both for research and later for marketing the technology), we are least worried about the Giga problems of the world like ignorance, malnutrition, unsanitary environments, poverty and unemployment-all roads that lead to illnesses that bring the hapless victims to doctors in the first place. Modern science has become a big business. Naturally, all and sundry jump on to the bandwagon of scientific research and are clamoring for patenting their wares! I hardly find anyone interested in finding out the truth. Fraud in research is a separate subject for discussion on another day. Fraud occurs because science has become a very lucrative business. It is no longer the preserve of great thinkers. Science has become another profession for survival! Money and fame have been the curse of science research. Awards and prizes add to this burden. We have wasted enough space in journals arguing as to why a particular finding does not fit our expectations but, do not bother to go deep to unearth the real culprit. There are so many imponderables in the game of prophecy in human affairs. The “Butterfly effect” of Edward Lorenz works in the human system as much as it does in any other dynamic system like the weather in the atmosphere. Genotype and phenotype apart there is the consciousness that must affect the final outcome in humans. We have no idea as to how it works! Partial knowledge of the initial state does not give credibility to our future predictions. Minor changes in the initial state could even result in catastrophic consequences. Changing the initial state partially might not hold good as time evolves; or might even result in greater damage. Most, if not all, our controlled studies, our interventional studies, as also our epidemiologic predictions have gone wrong in real life situations, causing so much human suffering and even deaths. I wonder why researchers do not take note of the fact that the third important cause of death in the US happens to be doctors’ interventions and the next, fourth, cause, the Adverse Drug Reactions.(2) If all our controlled studies were to be reliable this sorry state of affairs would not have come to pass. Before modern medicine finally falls as predicted by Le Fanu,(3) we better act! “Chance makes our parents, but choice makes our friends”, said Jacques Delille. If we want our patients to be our friends we must have the right choice of science. The future science is the science of chaos and wholism. Earlier we get out of the shackles of reductionism, the better for mankind. Amending the Mandelian Laws would not be enough as those are also reductionist ideas! I think we are paying a heavy price for having separated the mind from the body in biological research, following the advice of Rene Descartes. Time has come for us to realize that there is no body without the mind and there is no mind without the body. Mind (or consciousness) can not reside in an organ like the brain; it is universal. There have been attempts to revive the science of holism, chaos and non-linearity. Unfortunately, “truth will only influence half a score of men in a Century, while falsehood and mystery will drag millions by the nose”, wrote Aristotle. How true? The medical scientific community seems to be absolutely certain that the redcutionist ideas are the be all and end all of research. Let us remind them that it was Goethe who said that “man is absolutely certain only when he knows little; with (more) knowledge doubts increase!” Linear predictions of the Laissez faire have not worked in maximizing wealth. The gulf between the rich and the rest has widened so much that it is said to have reached its peak in the US now. Each time in history when this gulf widened economic depression followed like the depression of the 20s and 30s in the US. Mixed economies of Meiji Japan and Bismarck’s Germany clearly outperformed the free market linear economies of both Britain and France! When the US abandoned the Laissez faire of the 20s by accepting the proto-socialist policies of Franklin D. Roosevelt did the US come out of the depression.(4) “We regard the citizen who takes no part in these (public) duties not as unambitious but as useless…” wrote Pericles. Those of us who do not take interest in the public good of our patients would have to be labeled thus. The future is for non-linear economics like non-linear science! Both might see better future at least for our next generations. They have a right, otherwise, to hold us responsible for their miseries. "Those who will not reason
Yours ever, bmhegde Bibliography: 1) Firth WJ Chaos, predicting the unpredictable. BMJ 1991; 2) Starfield B Is the US medicine the best in the world? JAMA 2000; 284: 483-483. 3) Le Fanu J. The Rise and Fall of Modern Medicine. New York. Little Brown. 1999. 4) Freidman KS. Myths of the free market.Algora Publications. New York. 2005 Competing interests: None declared |
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Anthony Lwegaba, lecturer in Public Health, SCMR, University of West Indies, Cave Hill, Barbados
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I thank Smith DG and Ibrahim S for their article: What can mendelian randomisation tell us about modifiable behaviour and environmental exposure, BMJ 2005; 330: 1076-1079; is a good contribution to epidemiology. In their introduction, two points need clarification. Unintentionally, it was made to appear as if randomised controlled trials vs observation studies are not epidemiological studies. Since the crux of the matter is to control confounding and factors that are potential confounders arise from determinants of health that fall under four categories, they should be listed. First, biological environment: genes, their expression, physiological and anatomical function of ourselves and interaction with all biological organisms around us; second, physical environment: artificial or natural elements, structures, forces, uses and toxicity due to their physical and chemicals nature, climate, above and underground movements; third, socio-economic environment: culture, politics, education, nutrition, employment, attitudes, beliefs, and behaviour; fourth, health system: quality and quantity, accessability, equity, affordability, utilisation, coverage and appropriateness. As health is a product of the dynamic interactions of the above categories of determinants, the contribution that mendelian randomisation and analysis offers and its limitations can be appreciated in that framework. Competing interests: None declared |
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