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A higher form of truth
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A higher form of truth
Several years ago, I was invited to join a fellowship program at one of the most prestigious cardiac institutions in the USA. I recall that time as one filled with great joy (because I thought it would greatly help my career) but also in part tainted with some trepidation (because this place only attracted the best of best and I didnt think I was bright enough to be mingling with such people). In any case, I turned up with a promise to my self that I was going to make the best out of it.
In the first week, I was invited to a research meeting. As I walked in, I saw the chief of the research program at the head of a table and about 15 research fellows with their laptops open analysing their in-house database of patients. The atmosphere was tense, noisy and It all looked very daunting indeed. As new boy, I thought that the only way to try and create good impression would be to try and ask some kind of intelligent question. So I raised my hand and said the following: My name is Sanjay and I have just joined. Could I please ask what is the question that your research is trying to answer? I thought that that was a reasonable question to ask but I was surprised when suddenly the chief suddenly looked up stunned.
What do you mean question? The question comes last. First we mine the data and find statistically significant correlations and then we build a question based on the answers we find.
I kept quiet for the rest of the meeting. This just did not make sense.How can the answer precede the question? But as time progressed, I realised was a practice which was more widespread than I had thought and the reason is that medical research has also become a bit of an industry.
The way I see it is that research should be done to attain a higher form of truth and the only reward of that endeavour should be the attainment of a higher form of truth. As long as the question is a good question, and the experiment to answer that question is carefully designed and rigorously conducted, then any answer that it throws up, whether it shows a positive result or a negative result, is going to be valuable and would contribute to scientific progress. The reward is reaching a higher form of truth.
Unfortunately this is not the reward that many researchers seek these days.
It has become more about fame, money, more funding, job promotions and competition with colleagues. The more publications you have the more elevated your public profile. Researchers want to be involved with the biggest studies which need the most investment and often this investment is provided by pharmaceutical companies who in turn are really only interested in selling their product.
In addition, journals who publicise the research findings are also interested in selling their publications and therefore are less likely to publish studies that show a negative result as opposed to ones that show a more exciting positive result. Some editors see results which are ‘null’ as ‘dull’ and therefore not suitable for audience consumption. Sometimes organisational and business conflicts of interest also contribute to this publication bias. The problem is that it is the studies that are published in the biggest journals which are then used to develop medical guidelines and as I discussed in my last video, medical guidelines dictate how doctors manage patients.
The more critically I start looking at this the less confident I feel that the pills I so willingly distribute are as effective as they are purported to be. So as a doctor who set out wanting to make a difference, I often question what it is that I actually do. What difference is it that I actually make. As I have matured, I have started realising that perhaps the way to make a difference (in a profession that is riddled with vested interest)and to know that you are making a difference is to spend more time with patients, engage with them, empathise with them, educate them and empower them. Perhaps this is the higher form of truth that all doctors who truly want to make a difference should aspire to.
Several years ago, I was invited to join a fellowship program at one of the most prestigious cardiac institutions in the USA. I recall that time as one filled with great joy (because I thought it would greatly help my career) but also in part tainted with some trepidation (because this place only attracted the best of best and I didnt think I was bright enough to be mingling with such people). In any case, I turned up with a promise to my self that I was going to make the best out of it.
In the first week, I was invited to a research meeting. As I walked in, I saw the chief of the research program at the head of a table and about 15 research fellows with their laptops open analysing their in-house database of patients. The atmosphere was tense, noisy and It all looked very daunting indeed. As new boy, I thought that the only way to try and create good impression would be to try and ask some kind of intelligent question. So I raised my hand and said the following: My name is Sanjay and I have just joined. Could I please ask what is the question that your research is trying to answer? I thought that that was a reasonable question to ask but I was surprised when suddenly the chief suddenly looked up stunned.
What do you mean question? The question comes last. First we mine the data and find statistically significant correlations and then we build a question based on the answers we find.
I kept quiet for the rest of the meeting. This just did not make sense.How can the answer precede the question? But as time progressed, I realised was a practice which was more widespread than I had thought and the reason is that medical research has also become a bit of an industry.
The way I see it is that research should be done to attain a higher form of truth and the only reward of that endeavour should be the attainment of a higher form of truth. As long as the question is a good question, and the experiment to answer that question is carefully designed and rigorously conducted, then any answer that it throws up, whether it shows a positive result or a negative result, is going to be valuable and would contribute to scientific progress. The reward is reaching a higher form of truth.
Unfortunately this is not the reward that many researchers seek these days.
It has become more about fame, money, more funding, job promotions and competition with colleagues. The more publications you have the more elevated your public profile. Researchers want to be involved with the biggest studies which need the most investment and often this investment is provided by pharmaceutical companies who in turn are really only interested in selling their product.
In addition, journals who publicise the research findings are also interested in selling their publications and therefore are less likely to publish studies that show a negative result as opposed to ones that show a more exciting positive result. Some editors see results which are ‘null’ as ‘dull’ and therefore not suitable for audience consumption. Sometimes organisational and business conflicts of interest also contribute to this publication bias. The problem is that it is the studies that are published in the biggest journals which are then used to develop medical guidelines and as I discussed in my last video, medical guidelines dictate how doctors manage patients.
The more critically I start looking at this the less confident I feel that the pills I so willingly distribute are as effective as they are purported to be. So as a doctor who set out wanting to make a difference, I often question what it is that I actually do. What difference is it that I actually make. As I have matured, I have started realising that perhaps the way to make a difference (in a profession that is riddled with vested interest)and to know that you are making a difference is to spend more time with patients, engage with them, empathise with them, educate them and empower them. Perhaps this is the higher form of truth that all doctors who truly want to make a difference should aspire to.
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