Doctors are not scientists

A scientist, to me, is one who applies the scientific method, which,
beyond basic empiricism, is collection of facts, creation of a hypothesis
to explain the facts, and then (the step that is usually omitted because
of reasons listed below) testing that hypothesis by using all your
ingenuity to disprove it. Virtually everyone naturally does this provided
money and ideology don't get in the way, which they do most of the time.
Even a "scientist" who is a middle class wage earner falls victim to this,
designing research to best satisfy the person who signs the front of his
paycheck.Everyone,including "scientists," can be scientists when it is of
benefit to them. You might like anchovies and you might like mint ice
cream. You hypothesize that both together would be delectable to you.
You test. You falsify the hypothesis. Science is easy.

Although Einstein, in describing what a scientist does, stated "Above
all, never stop questioning" it would be absurd to think physicians could
embrace this essential quality of science since it would violate the money
and ideology supremecy principle in their lives. Physicians' livelihoods
depend on doing what is customary and usual ... the community "standard of
care". Oh, like theologians of old, they can safely question how many
angels can dance on the head of a pin, what kinds of dances would be
appropriate, etc. but they could never question that angels exist. An
example is in order here. Orthodox physicians, no doubt, argue all the
time about vaccinations, such as what dose to use, what frequency and at
what age they should be employed. But what do you think the professional
lifespan of a pediatrician would be if he or she questioned the medical
value of vaccinations in affecting the incidence of childhood diseases and
refused to administer them? I knew one such pediatrician who, in the
1970's refused to give pertussis vaccine because of, in his opinion, its
ineffectiveness and the morbidity and mortality associated with, possibly,
the endotoxin component. He claimed he never lost a patient to pertussis
but he definitely lost his license. Time has supported his views of
endotoxin toxicity of the old pertussis vaccine, and I never forgot his
argument for the ineffectiveness of vaccinations against childhood
diseases(which I listed several days ago in another submission and I will
repeat here in case someone can falsify it): "As for the benefit of
vaccinations themselves I have never had the following observations
answered to my satisfaction (and I have what must be everyone's personal
bias in wanting to believe that vaccines work and are safe). One may view
any almanac which lists the incidences of the major childhood diseases
(such as measles, diptheria and pertussis) from 1900 to 2000 or the
mortality from these diseases, and what is noted for all of them is
precipitous declines in incidence, most of which (sometimes over 90%)
occurred prior to the introduction of vaccines. And, of course, it would
be absurd to think that whatever was responsible for the dramatic declines
in these diseases prior to vaccination being used (such as, possibly,
improvements in nutrition, sanitation, and climate control)would disappear
the moment that vaccinations became available. I have to conclude
initially that only a small fraction of, say, 10% of the reduction in
these diseases were due to vaccination. But possibly vaccinations had no
effect at all, since diseases with no mass vaccination strategy show
similar decreases from very high to extremely low incidences over the
century (e.g. typhoid). Since I do not believe an effect can precede its
cause I can only conclude finally that, at least in the US from the period
1900 to 2000 and at least for the diseases noted, vaccinations had no
effect on the reduction in the incidence or mortality of the major
childhood dieases." So what's wrong with that reasoning?

Actually, all physicians in practice use a modified form of the
scientific method. As soon as the physician sees the patient walk in the
door he is gathering data. More data from the history, developing and
discarding hypotheses, testing them by directed questioning, physical
examination, perhaps with imaging and laboratory work, and then the
ultimate test, treatment. If the patient recovers this is evidence that
the hypothesis and treatment were correct (Recovery also supports the
dictum that the function of the physician is to safely entertain the
patient while nature heals him, so one should avoid smugness). If the
patient does not improve or worsens, though, the diagnostic and treatment
hypothesis were falsified. The weakness of this approach is the range of
hypotheses and treatments physicians are allowed to consider by their
administrative and academic physician masters (who have financial and
ideologic biases in spades). And above, all, the practicing physician
must NOT question, must NOT be a scientist, in anything other than minor
matters, not if he wants to get paid by insurance, not if he wants to keep
his license. A few years ago a physician acquaintence, a good family
doctor, in my opinion, "sold" himself to a large HMO-type operation.
After six months he gets the first letter from the administrator
suggesting he increase the frequency of his "patient encounters" but
added, with eye rolling boilerplate, "that he should keep the same high
quality of patient care he has demonstrated." All that means is less time
with the patient and more pills. Administrator happy, drug companies
happy, doctor probably not so, but he has complied. Patients, well, as
long as it doesn't cost me much.

Obviously, different areas in medicine are affected differently by
the pressures to be a non-scientist. For those specialties with rapid
confirmation of the benefits or dangers of intervention (e.g. any
structural abnormalities such as caused by acute trauma, severe
infections, major pain) medicine is more "scientific", (the hypotheses are
more likely to be unambiguously tested). But for the rest of the
profession...

In my opinion, Dr. Smith is basically correct in his assertion.

Competing interests:
None declared