Sunday, March 11, 2007

I seem to be starting too many blogs with the phrase “you couldn’t make it up”. Unfortunately, it so often seems to be the only thing to say. This time it was the revelation, in a previously classified report, that in 2002 the UK Ministry of Defence had spent £18,000 on a study to see whether psychics could discover what was in sealed brown envelopes. Strictly the study was compromised because the original protocol specified that the subjects should be “known” psychics but unfortunately when they contacted people who advertised their possession of these skills they were reluctant to put their skills to the test. The Ministry then recruited some “normal” volunteers. They promptly failed comprehensively to discover what was in the envelopes. What a surpise! It rather reminds one of the cartoon of the fortune teller’s stall bearing a sign “closed due to unexpected illness”.
Of course, it is not only the British Defence Ministry that engages in bizarre studies such as this. A recent book by Jon Ronson revealed the existence of a once secret US military unit engaged in a major programme of psychic and (pseudo-) psychological research. His book was entitled “
The men who stare at goats” because of the extensive use made by the researchers of goats whose vocal cords had been severed to stop them bleating. The idea was that if you trained yourself sufficiently intensely then you would be able to kill a goat (or in fact any other creature, including a human) simply by staring at it. Of course the military unit that dreamed this idea up didn’t stop there. One of its senior officers was convinced that if he could only get his mind into the right state he could walk through walls. He tried repeatedly but, amazingly, only ended up with a headache and a bruised nose.
It is, however, unfair to single out the armed forces in the US and the UK. Ronson’s book makes clear that many of these crazy ideas were taken up by large corporations, paying large sums of money to consultants, many of whom seemed positively certifiable, to motivate their staff.
This resonates with the 2006 Cochrane Lecture, which I gave at the UK Society for Social Medicine in September (to be published shortly in the International Journal of Epidemiology). The theme should in some way relate to Archie Cochrane, whose bequest endowed the lecture. He suggested that, if one plotted on a map of the world the number of randomised controlled trials, the lightest shading would be in countries that were communist or catholic. Coming from Northern Ireland I decided to leave the religious bit for someone else but I was able to examine the legacy of Soviet science for medicine. Briefly, science in pre-revolutionary Russia was vibrant and progressive. It survived the revolution for about a decade, until Stalin unleashed his new model of Soviet science. This rejected basic concepts such as a fair test and equipoise. After all, if the foundations of all knowledge had been set out by Marx and Engels, you could never begin from a position of uncertainty. The consequences were calamitous, especially in agriculture where Trofin Lysenko rejected modern genetics. Yet medicine was also badly affected. I argue that this actually suited the Soviet leadership because they never managed to create a modern pharmaceutical industry, instead relying on bizarre machines emanating light, x-rays, and the like. These had the advantage that they gave the impression that something was being done. They only needed electricity, which the USSR could distribute to its people, even if it couldn’t manage pharmaceuticals (or even sugar or jam…). Introducing concepts of evidence-based practice in this setting would have been disastrous! The trick, as it the men who stare at goats, is to exclude open peer review. Yet this is still going on. A seminal
report prepared under the chairmanship of Congressman Henry Waxman (D, CA), when he was minority leader of the House Committee on Government Reform catalogues the distortions of science under the administration of George W Bush. His report is frightening but it is also essential reading for anyone trying to make sense of today’s world.

No comments: