A year ago, the American Association for the Advancement of Science launched a companion magazine to it flagship Science. Titled Science Translational Medicine, the new magazine is intended to help connect the vast amount of research being conducted to the practical application of that science—that is, the translation of science into medical practice.
Last week, the new magazine carried an article titled “Closing the Scientific Loop: Bridging Correlation and Causality in the Petaflop Age” that tells volumes about why this is, for the most part, a misbegotten adventure. In principle, the idea that science should bring health benefits to us is an old and noble one.
A petaflop is a measure of computing power. The argument in the article is that there exists a bottleneck between the vast and expanding body of facts accumulated through experimentation on the one hand and slow progress in developing medical applications on the other. The article proposed so-called high throughput computer-based simulations that will open up understanding of medical conditions and their causes by rapidly evaluating the associations among the facts accumulated in the mountain of science.
This is a very old idea—as old as Sir Francis Bacon, the Sixteenth Century philosopher and statesman often credited with articulated much of what we now think of as the scientific method. A core Baconian principle is that through experimentation and the accumulation of facts, the working of the world will reveal itself to us. Bacon, of course, had no notion of petaflops or statistical simulations, but his idea is at the heart of what the Translational Medicine advocates.
Although the idea that truth emerges from facts sounds wonderful, the problem with it is revealed by the way in which Bacon actually expressed it. Describing how nature works, Bacon said that “she is either free, …or driven out of her ordinary course…or she is put in constraint, molded and made as it were new by art and the hand of man; as in things artificial…nature takes orders from man and works under his authority.” Feminist historians of science such as Donna Haraway and Carolyn Merchant appropriately point to the mischief and false promise of modern science arising from the identification of the natural world with the female and the need to have it, in Bacon’s words, “bound into service.”
In other words, modern science has an attitude problem. The collecting of facts and the emergence of practical knowledge from that accumulation is not the neutral process claimed by Bacon and those who have followed him down this latest installment in Translational Medicine. Creating usable knowledge—knowledge that brings us better lives—doesn’t emerge from a pile of facts but from the perspective we bring to that pile. And, by the way, what ends up on the pile also comes from that perspective.
Let me give you an example.
In the mid-19th Century, the death rate from diabetes was 1.4 per 100,000. At the beginning of the 20th Century, it was 22.9 deaths per 100,000. By the mid-20th Century it was up to 44.4 100,000. That’s an increase of 30 times over 100 years. With the rise of insulin therapy and pharmaceuticals, the death rate has declined to 24.1 per 100,000. However, the incidence of diabetes—that is, the number of people who are diagnosed each year—continues to rise. In other words, it’s a condition you’re less likely to die from today compared to 50 years ago but that you’re more likely to get.
The pile of facts about diabetes is very high. And yet what are the practical applications that have emerged from that pile? I’ll give you an example. In the 1970s a class of drugs that stimulate insulin production called sulphonylurias was introduced. They were widely prescribed. In addition to lowering blood sugar, they also caused heart attacks. Yet they continued to be prescribed so that, in one estimation, hundreds of thousands of excess deaths occurred. This last year we witnessed the same regulatory dance with the drug Avandia that also reduces blood sugars and causes heart attacks. It too is still being prescribed. The rationale is that the benefit outweighs the risk.
None of this contributes to treating the underlying cause of the diabetic disruption of our energy metabolism nor to preventing it from arising in the first place. Where would a sensible person look for practical things to do about preventing and actually curing diabetes?
A basic principle: health and illness arise from how an organism’s unique biology responds to its environment. What has happened to our environment over the past 150 years?
Recent research, for example, has found an association between diabetes and the body burden of persistent organic pollutants. That’s a clue, not an answer. It’s a small nugget in the pile of facts, a pile that’s dominated by facts about treatments using technologies such as drugs and surgery.
The clue about persistent organic pollutants is that the perspective scientists need to take in examining the pile of facts is that we, as a culture, have created technologies and environments to which our unique biologies respond badly. So the translation of science into practice needs to be about creating technologies and environments that actively promote health, environments to which our unique biologies respond positively.