{"id":2988,"date":"2016-02-16T03:18:01","date_gmt":"2016-02-16T02:18:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2988"},"modified":"2016-02-16T03:18:01","modified_gmt":"2016-02-16T02:18:01","slug":"the-unbearable-asymmetry-of-bullshit","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/","title":{"rendered":"The Unbearable Asymmetry of Bullshit"},"content":{"rendered":"

By Brian D. Earp<\/a>\u00a0(@briandavidearp<\/a>)<\/p>\n

* Note: this article was first\u00a0published online at Quillette<\/em> magazine<\/a>. The official version is forthcoming in\u00a0the\u00a0HealthWatch Newsletter<\/em>; see\u00a0http:\/\/www.healthwatch-uk.org\/<\/span><\/a>.<\/p>\n

Introduction<\/strong><\/p>\n

Science and medicine have done a lot for the world. Diseases have been eradicated, rockets have been sent to the moon, and convincing, causal explanations have been given for a whole range of formerly inscrutable phenomena. Notwithstanding recent concerns<\/span><\/a> about sloppy research<\/span><\/a>, small sample sizes<\/span><\/a>, and challenges in replicating<\/span><\/a> major findings\u2014concerns I share<\/span><\/a> and which I have written about<\/span><\/a> at length<\/span><\/a>\u00a0\u2014 I still believe that the scientific method is the best available tool<\/span><\/a> for getting at empirical truth. Or to put it a slightly different way (if I may paraphrase Winston Churchill\u2019s famous remark<\/span><\/a> about democracy): it is perhaps the worst tool, except for all the rest.<\/span><\/p>\n

Scientists are people too<\/strong><\/p>\n

In other words, science is flawed. And scientists are people too. While it is true that most scientists \u2014 at least the ones I know and work with \u2014 are hell-bent on getting things right, they are not therefore immune from human foibles. If they want to keep their jobs, at least, they must contend with a perverse \u201cpublish or perish<\/span><\/a>\u201d incentive structure that tends to reward flashy findings and high-volume \u201cproductivity\u201d over painstaking, reliable research. On top of that, they have reputations to defend, egos to protect, and grants to pursue. They get tired. They get overwhelmed. They don\u2019t always check their references<\/span><\/a>, or even read what they cite<\/span><\/a>. They have cognitive and emotional limitations<\/span><\/a>, not to mention biases<\/span><\/a>, like everyone else.<\/span><\/p>\n

At the same time, as the psychologist Gary Marcus has recently put it<\/span><\/a>, \u201cit is facile to dismiss science itself. The most careful scientists, and the best science journalists, realize that all science is provisional. There will always be things that we haven\u2019t figured out yet, and even some that we get wrong.\u201d But science is not just about conclusions, he argues, which are occasionally (or even frequently)<\/span><\/a> incorrect. Instead, \u201cIt\u2019s about a methodology for investigation, which includes, at its core, a relentless drive towards questioning that which came before.\u201d You can both \u201clove science,\u201d he concludes, \u201cand question it.\u201d<\/span><\/p>\n

I agree with Marcus. In fact, I agree with him so much that I would like to go a step further: if<\/i> you love science, you had better<\/i> question it, and question it well, so it can live up to its potential.<\/span><\/p>\n

And it is with that in mind that I bring up the subject of bullshit.<\/span><\/p>\n

Bullshit in science\u00a0<\/strong><\/p>\n

There is a veritable truckload of bullshit in science<\/span><\/a>.\u00b9 When I say bullshit, I mean arguments, data, publications, or even the official policies of scientific organizations that give every impression of being perfectly reasonable \u2014 of being well-supported by the highest quality of evidence, and so forth \u2014 but which don\u2019t hold up when you scrutinize the details. Bullshit has the veneer of truth-like plausibility. It looks good. It sounds right. But when you get right down to it, it stinks.<\/span><\/p>\n

There are many ways to produce scientific bullshit. One way is to assert that something has been \u201cproven,\u201d \u201cshown,\u201d or \u201cfound\u201d<\/span><\/a> and then cite, in support of this assertion, a study that has actually been heavily critiqued (fairly and in good faith, let us say, although that is not always the case, as we soon shall see) without acknowledging any of the published criticisms of the study or otherwise grappling with its inherent limitations.<\/span><\/p>\n

Another way is to refer to evidence as being of \u201chigh quality\u201d<\/span><\/a> simply because it comes from an in-principle relatively strong study design, like a randomized control trial, without checking the specific materials that were used in the study to confirm that they were fit for purpose<\/span><\/a>. There is also the problem of taking data that were generated in one environment and applying them to a completely different environment<\/span><\/a> (without showing, or in some cases even attempting to show<\/span><\/a>, that the two environments are analogous in the right way). There are other examples I have explored in other contexts<\/span><\/a>, and many of them are fairly well-known.<\/span><\/p>\n

An insidious tactic<\/strong><\/p>\n

But there is one example I have only recently come across, and of which I have not yet seen any serious discussion. I am referring to a certain sustained, long-term publication strategy, apparently deliberately carried out (although motivations can be hard to pin down), that results in a stupefying, and in my view dangerous, paper-pile of scientific bullshit. It can be hard to detect, at first, with an untrained eye\u2014you have to know your specific area of research extremely well to begin to see it\u2014but once you do catch on, it becomes impossible to un-see.<\/span><\/p>\n

I don\u2019t know what to call this insidious tactic (although I will describe it in just a moment). But I can identify its end result, which I suspect researchers of every stripe will be able to recognize from their own sub-disciplines: it is the hyper-partisan and polarized<\/span><\/a>, but by all outward appearances, dispassionate and objective, \u201csystematic review\u201d of a controversial subject.<\/span><\/p>\n

To explain how this tactic works, I am going make up a hypothetical researcher who engages in it, and walk you through his \u201cprocess,\u201d step by step. Let\u2019s call this hypothetical researcher Lord Voldemort. While everything I am about to say is based on actual events, and on the real-life behavior of actual researchers, I will not be citing any specific cases (to avoid the drama). Moreover, we should be very careful not to confuse Lord Voldemort for any particular individual. He is an amalgam of researchers who do this; he is fictional.<\/span><\/p>\n

Lord Voldemort’s “systematic review”<\/strong><\/p>\n

In this story, Lord Voldemort is a prolific proponent of a certain controversial medical procedure, call it X, which many have argued is both risky and unethical. It is unclear whether Lord Voldemort has a financial stake in X, or some other potential conflict of interest. But in any event he is free to press his own opinion. The problem is that Lord Voldemort doesn\u2019t play fair. In fact, he is so intent on defending this hypothetical intervention that he will stop at nothing to flood the literature with arguments and data that appear to weigh decisively in its favor.<\/span><\/p>\n

As the first step in his long-term strategy, he scans various scholarly databases. If he sees any report of an empirical study that does not put X in an unmitigatedly positive light, he dashes off a letter-to-the-editor attacking the report on whatever imaginable grounds. Sometimes he makes a fair point\u2014after all, most studies do have limitations\u2014but often what he raises is a quibble, couched in the language of an expos\u00e9.<\/span><\/p>\n

These letters are not typically peer-reviewed (which is not to say that peer review is an especially effective quality control mechanism<\/span><\/a>); instead, in most cases, they get a cursory once-over by an editor who is not a specialist in the area. Since journals tend to print the letters they receive unless they are clearly incoherent or in some way obviously out of line (and since Lord Voldemort has mastered the art of using \u201cobjective\u201d sounding scientific rhetoric<\/span><\/a> to mask objectively weak arguments and data), they end up becoming a part of the published record with every appearance of being legitimate critiques.<\/span><\/p>\n

The subterfuge does not end there.<\/span><\/p>\n

The next step is for our anti-hero to write a \u201csystematic review\u201d at the end of the year (or, really, whenever he\u00a0gets around to it). In it, He Who Shall Not Be Named predictably rejects all of the studies that do not support his position as being \u201cfatally flawed,\u201d or as having been \u201crefuted by experts\u201d\u2014namely, by himself and his close collaborators, typically citing their own contestable critiques\u2014while at the same time he fails to find any flaws whatsoever in studies that make his pet procedure seem on balance beneficial.<\/span><\/p>\n

The result of this artful exercise is a heavily skewed benefit-to-risk ratio in favor of X, which can now be cited by unsuspecting third-parties. Unless you know what Lord Voldemort is up to, that is, you won\u2019t notice that the math has been rigged.<\/span><\/p>\n

So why doesn\u2019t somebody put a stop to all this? As a matter of fact, many have tried. More than once, the Lord Voldemorts of the world have been called out for their underhanded tactics, typically in the \u201cauthor reply\u201d pieces rebutting their initial attacks. But rarely are these ripostes \u2014 constrained as they are by conventionally miniscule word limits, and buried as they are in some corner of the Internet \u2014 noticed, much less cited in the wider literature. Certainly, they are far less visible than the \u201csystematic reviews\u201d churned out by Lord Voldemort and his ilk, which constitute a sort of \u201cGish Gallop<\/span><\/a>\u201d that can be hard to defeat.<\/span><\/p>\n

Gish Gallop<\/strong><\/p>\n

The term \u201cGish Gallop\u201d is a useful one to know. It was coined by the science educator Eugenie Scott<\/span><\/a> in the 1990s to describe the debating strategy of one Duane Gish. Gish was an American biochemist turned Young Earth creationist, who often invited mainstream evolutionary scientists to spar with him in public venues. In its original context, it meant<\/span><\/a> to \u201cspew forth torrents of error that the evolutionist hasn\u2019t a prayer of refuting in the format of a debate.\u201d It also referred to Gish\u2019s apparent tendency to simply ignore objections raised by his opponents.<\/span><\/p>\n

A similar phenomenon can play out in debates in medicine. In the case of Lord Voldemort, the trick is to unleash so many fallacies, misrepresentations of evidence, and other misleading or erroneous statements \u2014 at such a pace, and with such little regard for the norms of careful scholarship and\/or charitable academic discourse \u2014 that your opponents, who do, perhaps, feel bound by such norms, and who have better things to do with their time than to\u00a0write rebuttals to each of your papers, face a dilemma. Either they can ignore you, or they can put their own research priorities on hold to try to combat the worst of your offenses.<\/span><\/p>\n

It\u2019s a lose-lose situation. Ignore you, and you win by default. Engage you, and you win like the pig in the proverb who enjoys hanging out in the mud.<\/span><\/p>\n

Conclusion<\/strong><\/p>\n

As the programmer Alberto Brandolini is reputed to have said<\/span><\/a>: \u201cThe amount of energy necessary to refute bullshit is an order of magnitude bigger than to produce it.\u201d This is the unbearable asymmetry of bullshit I mentioned in my title, and it poses a serious problem for research integrity. Developing a strategy for overcoming it, I suggest, should be a top priority for publication ethics.<\/span><\/p>\n

Footnote<\/b><\/span><\/p>\n

    \n
  1. There is a lot of non-bullshit in science as well!<\/span><\/li>\n<\/ol>\n

    Acknowledgement<\/b><\/span><\/p>\n

    This is a modified version of an article that is set to appear, in its final and definitive form, in a forthcoming issue of the HealthWatch<\/i> Newsletter<\/i> (no. 101, Spring 2016). See http:\/\/www.healthwatch-uk.org\/<\/span><\/a>.\u00a0Please note that this essay was first published online at Quillette Magazine,\u00a0<\/em>here:\u00a0http:\/\/quillette.com\/2016\/02\/15\/the-unbearable-asymmetry-of-bullshit\/.\u00a0<\/span><\/p>\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    By Brian D. Earp\u00a0(@briandavidearp) * Note: this article was first\u00a0published online at Quillette magazine. The official version is forthcoming in\u00a0the\u00a0HealthWatch Newsletter; see\u00a0http:\/\/www.healthwatch-uk.org\/. Introduction Science and medicine have done a lot for the world. Diseases have been eradicated, rockets have been sent to the moon, and convincing, causal explanations have been given for a whole range […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7933,394,328,475,397],"tags":[395,7967,137,304,565,7947,317,7942,2069],"class_list":["post-2988","post","type-post","status-publish","format-standard","hentry","category-brian-earps-posts","category-methodology","category-philosophy","category-politics","category-research-ethics","tag-bioethics","tag-bullshit","tag-ethics","tag-public-health","tag-publication","tag-replication","tag-research","tag-research-ethics","tag-science"],"yoast_head":"\nThe Unbearable Asymmetry of Bullshit - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Unbearable Asymmetry of Bullshit - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Brian D. Earp\u00a0(@briandavidearp) * Note: this article was first\u00a0published online at Quillette magazine. The official version is forthcoming in\u00a0the\u00a0HealthWatch Newsletter; see\u00a0http:\/\/www.healthwatch-uk.org\/. Introduction Science and medicine have done a lot for the world. 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Earp\u00a0(@briandavidearp) * Note: this article was first\u00a0published online at Quillette magazine. The official version is forthcoming in\u00a0the\u00a0HealthWatch Newsletter; see\u00a0http:\/\/www.healthwatch-uk.org\/. Introduction Science and medicine have done a lot for the world. Diseases have been eradicated, rockets have been sent to the moon, and convincing, causal explanations have been given for a whole range [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2016-02-16T02:18:01+00:00","author":"BMJ","twitter_card":"summary_large_image","twitter_misc":{"Written by":"BMJ","Est. reading time":"9 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"The Unbearable Asymmetry of Bullshit","datePublished":"2016-02-16T02:18:01+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/"},"wordCount":1848,"commentCount":1,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"keywords":["Bioethics","bullshit","ethics","Public Health","publication","replication","Research","Research Ethics","science"],"articleSection":["Brian Earp's Posts","Methodology","Philosophy","Politics","Research Ethics"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/02\/16\/the-unbearable-asymmetry-of-bullshit\/","name":"The Unbearable Asymmetry of Bullshit - 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