I have something that I thought I would add to a new section on the web site that deeals with being your own advocate, and understanding medicine and science for lay people. Perhaps we will call it Critcal Thinking and Good Decision Making for Cancer Patients. While it is not specifically cancer oriented, it does help distingush things so that people can develop sound opinions about the nature of science and the exploration of what we view as scientific thought, stated in very simple terms. Here it is for comment before I take it further to the web site proper. These ideas come from some rather good thinkers and not all from me directly.

Some Notes on the Nature of Science

The scientific method offers an objective way to evaluate information to determine what is false. The late astronomer Carl Sagan, Ph.D., has pointed out that "Science is a way of thinking much more than it is a body of facts.

A 1998 National Academy of Sciences book contains a superb chapter that distinguishes between facts and theories and between scientific beliefs and faith. Although the book focuses on evolution, its reasoning is equally applicable to health-related issues. The book states:

In scientific terms, "theory" does not mean "guess" or "hunch" as it does in everyday usage. Scientific theories are explanations of natural phenomena built up logically from testable observations and hypotheses. . . .

Scientists most often use the word "fact" to describe an observation. But scientists can also use "fact" to mean something that has been tested or observed so many times that there is no longer a compelling reason to keep testing or looking for examples. . . .

Usually "faith" refers to beliefs that are accepted without empirical [observed] evidence. Most religions have tenets of faith. Science differs from religion because it is the nature of science to test and retest explanations against the natural world. Thus, scientific explanations are likely to be built on and modified with new information and new ways of looking at old information. This is quite different from most religious beliefs.

Therefore, "belief" is really not an appropriate term to use in science, because testing is such an important part of this way of knowing. If there is a component of faith to science, it is the assumption that the universe operates according to regularities. . . . This "faith" is very different from religious faith.

The following ideas can help you evaluate information you encounter about science and health.

1. Science is a truth-seeking process. It is not a collection of unassailable "truths." It is, however, a self -correcting discipline. Such corrections may take a long time -- the medical practice of bloodletting went on for centuries before its futility was realized -- but as scientific knowledge accumulates, the chance of making substantial errors decreases.

2. Certainty is elusive in science, and it is often hard to give categorical "Yes" or "No" answers to scientific questions. To determine whether bottled water is preferable to tap water, for example, one would have to design a lifelong study of two large groups of people whose lifestyles were similar in all respects except for the type of water they consumed. This is virtually impossible. We therefore have to rely on less-direct evidence in formulating many of our conclusions.

3. It may not be possible to predict all consequences of an action, no matter how much advance research has been done. When chlorofluorocarbons (CFCs) were introduced as refrigerants, no one could have predicted that 30 years later they would have an impact on the ozone layer. If something undesirable happens, it is not necessarily because someone has been negligent.

4. Any new finding should be examined with skepticism. Healthy skepticism does not mean unwillingness to believe. Skeptics base their beliefs on scientific proof and do not swallow information uncritically.

5. No major lifestyle change should be based on any one study. Results should be independently confirmed by others. Keep in mind that science does not proceed by "miracle breakthroughs" or "giant leaps." It plods along, taking many small steps, slowly building towards a consensus.

6. Studies have to be carefully interpreted by experts in the field. An association of two variables does not necessarily imply cause and effect. As an extreme example, consider the strong association between breast cancer and the wearing of skirts. Obviously, wearing skirts does not cause the disease. Scientists, however, sometimes show an amazing aptitude for coming up with inappropriate rationalizations for their pet theories.

7. Repeating a false notion does not make it true. Many people are convinced that sugar causes hyperactivity in children -- not because they have examined studies to this effect, but because they have heard that it is so. In fact, a slate of studies has demonstrated that, if anything, sugar has a calming effect on children. If you say or hear it often enough, it becomes engrained in folk lore / or the public consciousness.

8. Nonsensical lingo can sound very scientific. An ad for a type of algae states that "the molecular structure of chlorophyll is almost the same as that of hemoglobin, which is responsible for carrying oxygen throughout the body. Oxygen is the prime nutrient and chlorophyll is the central molecule for increasing oxygen available to your system." This is nonsense. Chlorophyll does not transport oxygen in the blood.

9. There often are legitimate opposing views on scientific issues. But it is incorrect to conclude that science cannot be trusted because for every study there is all equal and opposite study. It is always important to take into account who carried out a given study, how well it was designed, and whether anyone stands to gain financially from the results. Be mindful of who the "they" is in "they say that . . . ." In many cases, what they say" is only gossip, inaccurately reported.

10. Animal studies are not necessarily relevant to humans, although they may provide much valuable information. Penicillin, for example, is safe for humans but toxic for guinea pigs. Rats do not require vitamin C as a dietary nutrient but humans do. Feeding high doses of a suspected toxin to test animals for short periods of time may not accurately reflect the effect on humans exposed to tiny doses over long periods of time.

11. Whether a substance is a poison or a remedy depends on the dosage. It makes no sense to talk about the effects of certain substances on the body without talking about amounts. Licking an aspirin tablet will do nothing for a headache, but swallowing two tablets will make the headache go away. Swallowing a whole bottle of pills will make the patient go away.

12. "Chemical" is not a dirty word. Chemicals are the building blocks of our world. They are neither good nor bad. Nitroglycerin can alleviate the pain of angina or blow up a building. The choice is ours. Furthermore, there is no relation between the risk posed by a substance and the complexity of its name. "Dihydrogen monoxide" is just water.

13. Nature is not benign. The deadliest toxins known, such as ricin from castor beans or botulin from the Clostridium botulinum bacterium, are perfectly natural. "Natural" does not equal "safe," and "synthetic" does not equal "dangerous." The properties of any substance are determined by its molecular structure, not by whether it was synthesized by a chemist in a lab or by nature in a plant.

14. Perceived risks are often different from real risks. Food poisoning from microbial contamination is a far greater health risk than trace pesticide residues oil fruits and vegetables.

15. The human body is incredibly complex. Our health is determined by many variables, which include genetics, our diet, our mother's diet during pregnancy, stress, level of exercise, exposure to microbes, exposure to occupational hazards, and pure luck.

16. While diet clearly plays a role in the promotion of good health, the effectiveness of specific foods or nutrients in the treatment of diseases is usually overstated. Individual foods are not good or bad, although overall diet may be described as such. The wider the variety of foods consumed, the smaller the chance that important nutrients will be lacking. There is universal agreement among scientists that a high consumption of fruits and vegetables is beneficial.

17. About 80% of illnesses are self-limiting and will resolve in response to almost any kind of treatment. Often, a remedy will receive undeserved credit. Anecdotal evidence is unreliable, because positive results are much more likely to be reported than negative ones.

18. There is no goose that lays golden eggs. In other words, if something sounds too good to be true, it probably is. As H.L. Mencken once said, "Every complex problem has a solution that is simple, direct, plausible, and wrong."

Is it your objective to "tune up" these assertions before you put them up? Do you want ideas about how to make these opinions more credible? This could become a wonderful section of the website - a sort of common sense primer. Many could benefit from it. It is my opinion that these opinions should be given with more citation and example. And a couple of the opinions might benefit from a bit of tweaking. Outstanding idea this. Tom

Please - anyone that thinks that they can add to or tweak this line of developing the ablilty to critically look at stuff - please post you ideas....I can use all the help that's out there. We are also going to put up a piece on bias as well that I am not writing myself, but it comes up in lots of scientific articles, so people should have a good working knowlege of it as well.... rip this apart, add to it, attack some of it if it's not right. It needs to be able to stand on both legs when it goes live on our website.

Brian, I sent you an email with comments. just wanted to say here that I think this is really good. It gets at a lot of the misconceptions about science that drive me crazy, so it must be on the right track

Nelie

<chuckle> When I sent you an email, I didn't realize your mail was being deluged by people wanting to talk to you about oral sex, Bill Clinton, HPV and oral cancer! I can post my comments here as well if you'd prefer.....

Nelie

If you post them here they may stimulate thought in others... please do.

On a continuing note: PLEASE STOP READING HERE FOR ANYONE WHO MIGHT BE PUT OFF BY SOMETHING OF A BAWDY OR ADULT IN NATURE!

There is a an issue of accurite observation that comes to mind when I think of scientic inquiry. Things require a focused perspective, and careful attention to all the details, as this story illustrattes.

First-year students at a Med School were receiving their first Anatomy class with a real dead human body. They all gathered around the surgery table with the body covered with a white sheet. The professor started the class by telling them: "In medicine, it Is necessary to have 2 important qualities as a doctor. The first is that you not be disgusted by anything involving the human body, it is a beautiful design in all respects."

For an example, the Professor pulled back the sheet, stuck his finger in the butt of the corpse, withdrew it and stuck his finger in his mouth." The he said "Go ahead now and do the same thing." The students freaked out, hesitated for several minutes, but eventually took turns sticking a finger in the butt of the dead body and sucking on it. When everyone had finished, the Professor looked at them and told them, "The second most important quality is observation. I stuck in my MIDDLE finger, and sucked on my INDEX finger. Now learn to pay attention."

Sorry but it was such a good observation and story.....

well it's a good thing I wasn't doing my swallowing practice while reading here...I would have spurted coffee all over the computer screen....

OK. My initial thoughts on what you wrote.

1. I understand why you are saying " "belief" is really not an appropriate term to use in science, because testing is such an important part of this way of knowing" but later on when you address what skepticism means you talk about skeptics basing their beliefs on scientific evidence. I can see someone being confused by these two things together. Perhaps instead of saying "belief is not really an appropriate term to use in science" it might be better to say "belief is a term that means something very different when we are talking about scientific beliefs because testing is such an important part of this way of knowing".

2. I found myself wanting to add more to number 2 about certainty being elusive in science. First, although you can come pretty darn close to certainty about some well-established findings, technically certainty is actually nonexistent. Science is based on induction and induction never allows us total certainty. I know this is probably a technical quibble and allows people who misunderstand science to then say "well, if nothing's certain then my theory is as good as yours".

I hate when people do that.

Which is why I also find myself wanting to add something to the end of number 2 such as

"As such, scientific conclusions are always open to challenges based on the method used to draw the conclusions. This does not mean, however, that conclusions based on scientific evidence are equivalent to conclusions based on other forms of belief (such as beliefs based on the statement of an authority figure, beliefs based on faith, etc.)"

This may be muddying the waters of layperson comprehension more than you wish to do.

I also wanted to add something about this to what you said about skepticism. Something such as "Skeptics are also willing to revise their beliefs in light of sufficient new information. Fundamentally, scientific skepticism never accepts a belief with certainty but with a higher or lower probability of being true".

Again, I don't know if this is just muddying the waters or not.

In number 6 on the point about correlation versus causation I wonder if it would be worth pointing out that an association of two variables CAN be determined to be a causal association under the condition where all variables except the variable thought to be the cause are random or held constant and that these conditions are exactly what Phase III clinical trials are about. I know the disinction between a true experiment and correlational research is a lot to expect people can wrap their heads around from a single sentence or two(I've taught plenty of undergrads who can't wrap their heads around it in a semester) but I hate to leave people with the impression that no research can ever draw valid conclusions about cause and effect.

In number 15, I wonder if it would help to also add the following:
"Further, many health variables interact with each other which means that, in any specific case, you cannot draw conclusions about the effect of one variable without knowing about the state of other variables."

These are my comments for now! I won't be offended if you totally ignore all of them. I realize that every addition that makes a bullet more precise also adds complexity and may make it seem more confusing. I always struggle with that in the materials I create for students and I usually start with too much complexity and then slowly simplify--I'm not so good at starting from the simple. I'll be interested in reading other people's feedback as well.

Nelie

Before he retired, my father was an executive with the Howard Hughes Medical Institute. At one of their many functions (of which I attended very few), a Nobel Laureate in Medicine commented that the "Practice of Medicine is as much art as it is science" . . . seems apropos to this topic.

Best.

Tim

I'm hearing the strains of "She Blinded Me With Science" by Thomas Dolby every time I think about this thread.

If you REALLY want to know all there is about "The Curious Lives of Human Cadavers" you MUST read "Stiff" by Mary Roach. Hilarious, believe it or not. You will learn a whole lot about the "Art" part of medicine in this book.

I am now reading "Spook" by the same author (AKA "Science Tackles the Afterlife") I'm up to chapter 3. Same style and equally funny. Very well researched. Strictly from a scientific, non-religious, respective. Order it through OCF and a small portion goes back to the foundation.

Brian - is there a way to 'shape' the discussion board so that a small window area could run a series of "factoids" kind of like a banner ad or a billboard. Here is my reasoning. This site now has SO MUCH information on it, that important pieces may be lost to all but the most persistant surfers.

What if you sent all your "regulars", the folks who have been here a while, out to the blog pages and have them select the TOP 50 tips for site users. It seems we all repeat ourselves and each other so much each time a new person signs in. Perhaps a revolving billboard window could run those TOP 50 tips and save some of the repitition and deliver really important factoids, like you ones you are proposing here to all visitors.

The revolving billboard could have links on it that allowed a curious visitor to click on a message and be taken straight to that section of the web site for more detail. The regulars here would soon learn the numbers of tips they want a particular person to see and recommend it to them. "Welcome Linda, be sure to visit the XXX board and read clip number 37. It really fits your situation"..... etc. A quick and accurate way to deliver precise, articulate and appropriate advice with a mouse click.

Just a techno thought. Tom