DOCTOR'S HANDWRITING - by Peter Mansfield, M.D.

The Ecologist June 2002

(printed with permission from the author)

Columnist Peter Mansfield resigned as a GP following attacks on his stance against the MMR vaccine. He now runs GoodHealthkeeping. The practice aims not just to cure illnesses, but to educate people how to avoid becoming ill in the first place. This month he asks why we assume scientists have all the answers, and what do we do if those scientists are the problem . . ..[here follows Dr Mansfield's article.].

Last week I was asked by a group of anti-vivisectionists to discuss on radio a WHO report about the use of primates in medical research. I declined, despite strongly held views. Sound bites may be the oxygen of broadcasters, but they make for very unsatisfactory debates.

It always comes down to what you choose to assume. No science is possible without making some assumptions from which questions are framed for the scientist to answer. To start with, we assume that the methods of science are appropriate for answering questions.

That in itself may not be a problem. The trouble is that we let scientists ask the questions as well as answer them. That is unwise, because scientists tend to ignore the big picture in favour of their special interests. Inevitably, they frame questions which they will enjoy tackling. They then invariably find that the answer, at least in part, is the need for more research.

In consequence, we find ourselves endorsing a huge haze of abstract ideas we do not understand. We, our politicians and commentators avoid challenging these ideas, lest we appear foolish. The scientific establishment, meanwhile, seldom admits to the fragility of its ideas - far less its assumptions. It has awarded itself a god-like status, and we tolerate that.

But what if scientists' undeclared assumptions are in fact false? In that case, any questions and answers that follow from them will merely compound the initial falsehood.

Take research on primates - or any other animals, come to that. The initial assumption goes like this: human rights supersede animal rights. It matters not that the human disease being researched might result from self-abuse - the wrong food, or too little exercise, for instance. No, we conduct research on animals to find cures for our self-inflicted illnesses, instead of looking at what we are doing wrong so as to stop these illnesses from occurring in the first place. 

Secondly, we assume that similar genetic codes mean similar animals. Yet the few genes that distinguish us from other mammals cannot possibly account for the striking contrasts in form, function and talent. Genes are the same in all the cells of one individual, yet different cells within the same animal have radically different forms and functions. What makes one cell part of your eye, another your heart and another your brain? Hi-tech gene-speak only camouflages our ignorance.

Ostrich mentality

In September 1997 The Lancet - an internationally respected journal of medical science - published an analysis of the findings of a series of scientific trials of homeopathic medicine. It set out to check whether the apparent benefits of homeopathic medicine were actually just examples of the placebo effect - in plain language, self-delusion. 

 The result was positive. The studies found that homeopathic remedies did indeed have a net positive effect after self-delusion, bias and all other confounding factors had been carefully ruled out. The paper then survived review by at least two other experts before The Lancet agreed to publish.

Even then, in the same edition The Lancet published not one but two leading articles by placebo sceptics. One simply refused to accept the result at face value - ultimately, because the "infinite dilutions" of the agents used cannot possibly produce any effect'. The other conceded that 'there is enough in the study to [ask] for good controlled trials', but doubted whether resources [for] these trials can be justified when a rational basis for... homeopathy... is lacking'.

In other words, even though a system of medicine has effectively been acquitted of quackery in the highest available scientific court, it remains in the dock because the scientists don't know how it works.

That's as philosophical as it gets. Fixed mind-sets and vested interests are the usual obstacles. The UK's Medical Research Council (MRC) is, for example, about to publish its thoughts on how to fill the embarrassing black hole in research on the fluoridation of water. A fabric of dogma, constructed through 70 years of tendentious research, hailed water fluoridation as the best way to correct inequalities in dental health. That dogma began in the US with the then reasonable assumption that people only obtained fluoride from water. But Americans don't drink much tea, which is a rich source. And then toothpaste became fluoridated anyway, and food items began to be processed and manufactured with fluoridated water.

Now, the facts are that many people in non-fluoridated areas consume as much fluoride as those with fluoridated water supplies. Sometimes they consume a lot more fluoride than could ever possibly be good for them. This effectively rubbishes all the studies that compared populations simply on the basis of the fluoride content of their water supply. Yet it took a systematic scientific review and about five years to force dental academics - their banners long nailed to fluoridation - to take intoaccount personal consumption of fluoride from all sources. Wehave yet to see if this concession finally makes it into the MRC report.

I can't help noting the parallels between the fluoridation saga and the way the MMR story is unfolding. Creating MMR was little more than an act of technical cleverness. But it also exceeded nature, and was, therefore, wrong in principle. But so little do its protagonists care for public opinion that they intend to compound the error by adding chicken pox vaccine to MMR. It will then become a quadruple hit. A pathologist friend of mine reacted to this proposal with dismay: 'Two immuno-suppressant viruses in the same vaccine? Whose bright idea was that?' Were he a pharmaceutical industry employee instead of a private practitioner, he wouldn't have to ask.

This sort of 'science' abuses both the resources and trust of the public. As Richard Asher said: 'If you can't explain a complex technicality to your landlady's daughter, you don't understand it yourself.' Nor are you earning your corn.