What is Science? And Why You Should Care?
Section titled “What is Science? And Why You Should Care?”Over the past couple of years, I've seen half a dozen patients choose magic over science. It happens like this. A man sits in my office looking overwrought. A month ago I sent him to a specialist about a suspicious lump, and now he has a diagnosis of cancer. The oncologist prescribes a course of chemo and radiation and tells him, quite honestly, the chance of success is less than 100 percent. "I've read that some oncologists advise chemotherapy even when the benefits are marginal," he tells me. "I've found this alternative doctor in Vancouver, BC. He uses a special mushroom that can cure my kind of cancer." I advise my patient to stick with the less-than-perfect established therapies, but he's drawn to the impossible promises more than to science. His unhappy experience then shows both of us that the doctor in Vancouver was dead wrong.
What is science? Most of us, I suppose, think of abstruse equations written on a chalkboard or imagine someone in a white lab coat holding a test tube. News just in. Science has zip to do with those things.
Science, the Latin word for "knowledge," simply refers to those observations about the world that can be replicated over and over again by different observers. Drop a big rock on your bare foot and it hurts and turns purple. Your neighbor, dropping a rock on her foot, gets the same results. This fits the definition of a scientific fact because it happens every time, regardless of religion or beliefs. You don't need to take it on faith; you can check it out yourself in your own home.
Every infant and toddler is a scientist, always testing, always asking questions. "What happens if I drop this bowl of oatmeal from my seat here in the highchair?" "Will I get the same shape puddle if I tip over this glass again?"
True, the search for more knowledge and understanding of nature often takes place in the lab or the proton accelerator, but that's the rarefied stuff. The essence of science is not scientific lingo or fancy tools, but the childlike ability to learn from what we see and the willingness to test those conclusions.
The key is dispassionate observation, as demonstrated by the honest oncologist who says, "We know we can improve your chances. But truth to tell, we've done this many times and we know it doesn't always work. We're working to improve it." Why is this humble attitude important? Because your and your doctor's dispassionate approach to what is known about your condition can save your life.
Fake Science - a Dangerous Game
Some people employ scientific language to mislead. Usually they are selling something. For example, some quote a few "scientific" studies supposedly proving that mushrooms cure cancer. They leave out the fact that the studies were done on gerbils. Maybe they don't even know the details. Then they tell credulous people that the mushroom can cure their cancer.
An education in basic science can be literally lifesaving in this situation. Education in science gives us comfort in the presence of complex ideas, gives us the habit of questioning those who propose new ideas, shows us that wrong ideas can be expressed using scientific words, and gives us the skills to separate fact from fancy. Then we can evaluate claims clothed in "scientific" terms. We learn that animal studies may or may not be applicable to human beings. We learn that small studies on a few subjects are not as determinant as large studies carefully designed to avoid error. We look at who paid for the study, who conducted it, and what other elements may affect the results. We consider how the results fit in with what we already know.
Without the ability to tell good science from fake science our health is at risk.
Sorting Through the Facts
When we direct our efforts to discovering "what the world is really like" with as few preconceptions as possible, we are better able to tease fact from fancy. I've seen some cancer patients who follow every medical recommendation and some who negotiate a modified treatment plan. Either can be a healthy choice depending on circumstances. Our best shot comes when people learn as much as they can about the real world, put aside their preconceptions as best they can, and make a reasoned choice.
Are Doctors Scientists?
That depends upon how you define science. Once, I'm told, Einstein stood before a room full of doctors and told them "You are not scientists." By this I think he meant that a true scientist seeks an understanding of the physical world with no goal other than the understanding itself. To Einstein science was knowledge for the sake of knowledge.
A physician practices not "pure" but "applied" science. He or she uses science not as an end in itself, but to help the patient. If we can help you get over your severe back pain without an MRI, we will. The MRI will give us greater knowledge, but the knowledge from the MRI often distracts us from less technologically impressive but more important facts. In fact, MRI images have been shown to increase medical interventions and costs with no improvement in ultimate outcome. The MRI fee of $2000 out of our patient's pocket may be too high a price for knowledge that doesn't really aid healing.
So, in medicine, we use science, we use knowledge, but the knowledge is not an end in itself as it was for Einstein.
Assuming you, dear Reader, are not engaged in a hard science such as physics, you can be a scientist in the same sense your physician is. You can use knowledge to achieve a goal. If you can ask questions, if you are not afraid to spend some time in an effort to understand new concepts, if you are humble and open-minded enough to accept conclusions that differ from your preconceptions, then you are using a scientific approach. You may have found that sometimes you err in your analysis of different situations, as all scientists sometimes do. When this does not stop you from your search for understanding, when this does not undermine your confidence in yourself, you are a scientist.
Colon Cancer Screening
Section titled “Colon Cancer Screening”When early identification significantly improves your chances of surviving cancer, then screening for that cancer has value. However, when early identification does not significantly improve your chances of surviving cancer, then we don't screen. For example, pancreatic cancer is deadly even if we identify it early, so we don't screen.
As we age, we can develop polyps (pronounced "paul lips") in the colon, shaped something like the little skin tags we can develop on the skin. Most polyps are benign, but some can develop cancer at their tips. If this is discovered by screening, and removed, the cancer is terminated as surely as a skin cancer is if it is excised before spreading. However, ignore that cancerous polyp, and the horse can escape the barn.
There are two general methods to screen for these polyps and early cancers. One is colonoscopy, "the tube." Colonoscopy costs in the range of $1500 to $2000 and usually is done every five to ten years. One advantage of colonoscopy is that if a polyp is discovered, it can be removed during the procedure.
The second method is a little kit you use at home to take samples which the lab will use to test for hidden blood in the stool. Doctors called "hidden blood" occult blood, and the test is called "fecal occult blood testing" or FOBT. The test costs about $18 and should be done every year.
In our July, 2005 newsletter we reviewed in depth the relative merits of colonoscopy and FOBT. To bring you up to date, Australian physicians found that screening with colonoscopy averted 31 percent of the deaths from colorectal cancer, compared to 29 percent averted with annual FOBT. That's a pretty good showing for the inexpensive FOBT, I'd say. (Read more, die-hards, at J Gastroenterol Hepatol 2004 Jan;19(1):38-47)
We mentioned the new kid on the block in our earlier newsletter, but the test has just become easily available. The immunochemical FOBT (iFOBT) test for hemoglobin in the stool requires no special diet and only one stool specimen instead of three with the older FOBT. Whereas an annual FOBT picks up in the range of half of colorectal cancers, the iFOBT picks up 80 percent or more. Further, the iFOBT is less likely to be falsely positive, which should allow one to avoid unnecessary colonoscopies, the follow-up test to a positive FOBT.
Either the FOBT and iFOBT should be done annually. The former costs $18 at our clinic, the latter $90.