Checkup

Vital Signs

Questions and Answers

Dr. George Bartley

Dear Readers:

As I write this column, the headlines convey the worrisome discovery that several popular medications have potentially harmful side effects. The fate of these drugs at this point is unknown, but the discussion reprises a question I've often heard from patients: "Why can't doctors and researchers make up their minds?"

It's a valid query when one considers what has been accepted as medical dogma in recent years. Low fat/high carb diets help you lose weight; low fat/high carb diets make you gain weight. Don't eat eggs; eggs are OK. Ulcers are caused by stress so treat them with milk; ulcers are caused by germs so treat them with antibiotics. No wonder people feel whipsawed.

Rather than viewing these about-faces as an indictment of research, I prefer to regard shifting viewpoints and contradictory recommendations as a validation of the scientific method, which is the systematic way that scientists and researchers approach their work. They observe what happens, identify a problem or ask a question, come up with an explanation (or hypothesis), predict how the hypothesis might answer the question, design and conduct an appropriate study or experiment to test the hypothesis, analyze the results, and arrive at a conclusion. Following such a formula usually invites additional questions rather than settling an issue "once and for all." Science advances (and scientists become famous) when old buildings are knocked down and replaced with sturdier materials.

It's pretty clear that few ideas are cast in stone. But how can this year's study turn last year's study on its ear? In part, it's the result of improvements in the middle sections of the investigative process. People have always been watchful observers with lots of questions about how the world works. Similarly, the ability of smart men and women throughout history to "connect the dots" from limited information to profound concepts is astonishing. Consider the first person who figured out that the world must be round rather than flat because he or she saw the mast of a ship before its hull when the vessel came over the horizon. Or that Isaac Newton worked out the mathematics of the ocean's tides . . . without leaving his study in Cambridge. Impressive!

The core of research — how we formulate questions, design experiments, and analyze results — has come a long way in a short time. When I read research studies from my medical school days, I am amazed by how primitive some of them were. Frequently, there was no control group, or confounding variables were not excluded, or statistical analysis was meager or absent. Despite using imperfect tools, however, researchers made important discoveries. Fortunately, the tools of the scientific method are constantly being refined.

So, rather than being disheartened when medical "truth" varies from year to year, each of us can help to advance medical knowledge. One way is to be a subject in a clinical trial if given the opportunity. Another means is to support research funding through the National Institutes of Health or through institutions such as Mayo Clinic. And finally, we can make observations about our own health and ask our doctor questions. Many research studies — and many important answers — have resulted from such inquiries.

Sincerely,

George B. Bartley, M.D.
Chair, Board of Governors
Mayo Clinic Jacksonville