THE 'SCIENTIFIC CITIZEN'

THE DANGER OF UNQUESTIONING 'TRUST'

by Kathy Gyngell

Read the full article here. Summary below.

 

Was anyone else more than a little disturbed by Professor Martin Rees' call in his Reith Lecture for public policy choices "to be leveraged  by 'scientific citizens'?

His impossible quest for consensus in interpreting scientific evidence to enable government to correctly manage future risk and uncertainty on our behalf, risks a science/ state symbiosis as unhealthy as that between religion and the state of the past.

The idea of scientific citizens tasked with stamping brand 'trust' on science whilst mediating what we think is the last thing we need just now.

 In case he hadn't noticed, scientific citizens already abound demanding deference to the authority of science, whatever the dimensions of the topic in question.  Last month's launch of the International Centre for Science in Drugs Policy marked a new development. Its mission to build a network of scientists "to speak out about evidence based drugs policy", played up scientists as victims of a state of scientific evidence repression and suppression. But in fact all that the non sequitur boiled down to was a disapprobation of law enforcement in the name of science; an arbitrary characterisation of the focus of 'today's drug policy efforts' which excluded any mention of 20 years of investment in 'harm reduction' goals, to which  policy failure can equally be attributed.

 Bertha Madras, professor of Psychobiology at Harvard Medical School's Department of Psychiatry, is also concerned with science in drug policy. Yet her conclusion - that 'prevention with drug control policies involving parents must be the first line of defence' - could not differ more from theirs.   

... Then there is the recent promotion of narrowly 'correct' results of a small, though expensive, trial of experimental heroin prescribing published recently in The Lancet. The authors' conclusions suggest that it is scientists' reason, more than technical 'error', that needs questioning.

This trial demonstrated that medically prescribed heroin resulted in a statistically significant decrease in street heroin use by the heroin addicts given it (over those medically prescribed injectable methadone and oral methadone). As a result the authors have confidently advised government to "roll out" proposals "to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts".

The results should hardly come as a surprise - the heroin to which they were addicted didn't involve stealing for and was dispensed twice day in a friendly caring environment.

 This was a poor outcome for the already low threshold of success set by the research design.  Only one eighth of patients, just 5 in all, of the 43 in question, became 'abstinent' from street or illicit heroin despite  a heroin dosage of 450mg twice a day plus a nightly oral methadone supplement over a  26 week period (not abstinent as we would understand the term - only from illicit heroin, nor from crack, alcohol or cannabis). 

No amount of complex logical regressions or statistical dressing up make this marginal response to a combination of free, safe handouts and psycho-social care (the contribution of which is not assessed) something that could in future justify such expensive use of scarce health resources.