Scientific research is grey

A key reason why flaws and deceit are rampant in research is that there are no straightforward yes/no answers to all studies. A few decades back, in the early 1990s, there was compelling evidence that beta-carotene protected against cancer. Laboratory studies, animal studies, observational studies – everything was in favour of this antioxidant found in fruits and vegetables. Many scientists themselves took beta-carotene supplements. Then came three large clinical trials that were conducted on heavy smokers and asbestos workers, and the beta-carotene hypothesis crumbled. The trials concluded that not only beta-carotene failed to protect against cancer, but also increased its risk for some patients. Statins have an opposite story. The USFDA warns on statin labels that they may cause memory loss. But a recently-concluded six-year study led by Syndey’s Garvan Institute of Medical Research reveals no link between the two.

 

Who and what do you believe? And can we, or can we not, trust scientific research? The truth is, while research isn’t serendipitous, there are several variables at play; tweaking even one of them, can alter results dramatically. For instance, it is possible that beta-carotene may benefit non-smokers. Also, patients on statins are likely to be older, whose brain tissues face a natural degeneration. If statin studies are appropriately controlled for age, a true picture would emerge. But adversaries of statins can make the cholesterol-lowering drugs the easy miscreants of dementia by tweaking data.

 

In the quest for medical truth, it is hard not to be fooled. Clever researchers can use several extraneous factors to make a drug look good. Or a competing drug look bad. In a paroxetine study, the drug was compared with amitryptyline, both antidepressants. But the latter was an older drug that could make people drowsy, and hence was typically prescribed only before bedtime. Yet in the trial, it was administered twice a day, making paroxetine look much better. Similarly, study after study had found that women taking estrogen had less heart disease than women who did not. But the fact is that women who faithfully take any medication for years – even a sugar pill – may be healthier because they are the compliant sorts.

 

In general, studies could be flawed because they are too small (such as the cotton mask research mentioned in the previous post), they ignore differences in patient groups (such as the hydroxychloroquin and estrogen researches), they are stopped too early because results are positive for drugmakers (more in another post), they make inappropriate comparisons (such as the paroxetine research), and so on.

 

It is also helpful to remember that while there is outright, unpardonable fraud that can exaggerate benefits and underplay harms of treatments, it is also perfectly possible for good people to conduct bad trials, without ever realizing it. Scientific research is full of grey and fuzzy areas. Scientists are also asking more questions as research evolves. So what was true yesterday, might be false today. The only rational choice is to not take any trial on its face value and judge each one on its own merit.