“Science cannot lie…” – Adolf Hitler
“The Stone Age may return on the gleaming wings of science.” – Winston Churchill
I am a Catholic and a physician. As a convert to the Catholic Faith, many have asked me to explain my faith and offer reasons for perceived shortcomings in the Catholic creed. “Why do you believe…?” “How can you justify…?” Rather than becoming defensive, I have found myself eager to answer such questions. After all, at one point, these questions were my own. I came to Catholicism, in part, because it is a beautiful repository of wondrous faith and scintillating reason.
Curiously, however, no one has ever asked me as a practicing physician to explain my faith in medicine. An obvious question for a field that inaugurates its practitioners with an oath to “First, do no harm.” And yet, this question is taken for granted because medicine is a science. As such, it is considered honest, true and self-correcting.
But let me offer a few insights I have gained from my experience practicing medicine and trading in the wonders of science.
Science is a wonderful tool. For fifteen years, I have been practicing internal medicine and have found myself repeatedly humbled by what medicine can do. A man rushed to the emergency room with an evolving heart attack can have a catheter threaded into a groin artery and a life-saving stent placed in his occluded vessel.
A woman presenting with an acute stroke can feel her left-sided weakness resolve shortly after the thrombolytic (“clot-busting”) medication is infused. A child ravaged by leukemia has a future on the playground and baseball diamond thanks to modern chemotherapy. And I am not even discussing the extraordinary treatments for sepsis, heart failure, or pre-term infants. Indeed, science can be a wonderful tool.
But it can also be a lousy one. For years we advised everyone to follow a low-fat diet. And we were wrong. Post-menopausal hormone replacement therapy has few downsides, we assured people. Except that it actually does. Take these antioxidants, check your homocysteine level, don’t forget extra doses of fish oil. Wrong, wrong, wrong. And I’m not even discussing prostate cancer screening, vitamin D replacement, and thalidomide in pregnant women. Science gave us assurances on all of these things. Until it didn’t. Science can be a lousy tool.
I am not an apostate from traditional medicine who will now sing the praises of exotic herbal cocktails or trumpet the lost art of phrenology. No. I’m simply being realistic. Science is a wonderful tool, but it can be wrong. I would wager that more money is spent on “getting medicine right” than almost any field of endeavor (save oil and nuclear research). Why is this the case?
Just consider for a moment. What other field affects more people, more intimately, with more at stake if you get it wrong? From vaccinations to antibiotics to screening exams to surgical procedures, everyone is touched by medicine. And yet, in spite of gold standard randomized, double-blind, placebo-controlled trials…we can still get it wrong.
A good friend and physician-researcher, Dr. Michael Cummings, reminds us that human bias, surrogate markers, inappropriate extrapolation, and simple chance (remember that even the study deemed “statistically significant” grants a 5 percent likelihood that its results are from chance alone) can confound our best efforts at certainty.
But is this surprising? It shouldn’t be. A system of interpretation built and operated by fallible mankind will never be rid of elements of fallibility. Our approximation of certainty is just that: an approximation. An asymptotic line never achieves its perfect end, but runs on forever with its sliver of error intact.
For science to be operational, we have to (if I may say it) have a little faith. There is uncertainty and imperfection. There is mystery that constantly spurs the scientific quest on, but also chastens us in our cocksureness. There are assumptions – there need to be assumptions – that establish our starting points and first principles of science. And that is okay.
But. . . .
It is when this fundamental truth of science – its very fallibility – is forgotten that we get into trouble. When we believe our assumptions are solid, indisputable facts, we become overconfident. And unbeknownst to us, we risk science insidiously morphing from a helpful tool into an intolerant dogma. We refuse correctives. We dismiss dissent.
Behold, the tool of science becomes the ideology of science. And the potential for harm multiplies. Perhaps Hippocrates, the father of medicine, said it best. Upon considering the weaknesses and tendencies of man and his craft, the great physician’s advice could be reduced to a mere handful of words, Primum non nocere. First, do no harm. He said this for a reason.
As a Catholic and a physician, I still believe in medicine. I believe in the efforts I can make to collaborate with my patients to live fuller, richer lives. I am not cynical. But I am reminded daily that medical practice is fraught with both wonder and shortcomings. I am cautioned to be humble in practice and understanding. Medicine is an imperfect science and I am an imperfect person.
It has been fifteen years since I started practicing medicine. What have I learned? Science is a wonderful tool…and, at times, a lousy tool. But it is an unreliable creed and a terrible dogma. We should ask the same questions of our science that we often as of our faith.
Yes. First, do no harm.