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Understanding how scientists make decisions about your child's health

There’s been a theme running through conversations I’ve had lately. I and some of my more scientific friends have been noticing a general lack of understanding about how science works and what makes the scientific method worth considering.

First, a caveat. We all know that doctors have been wrong. So giving examples of when a medical approach turned out to be wrong doesn’t actually cancel out any of the information below. In fact, it confirms it. Science can handle mistakes — magic can’t.

So here’s the scientific method in a nutshell: Scientists noticed that if they could get a large sample of a phenomenon (let’s use human disease in this case), they could make general predictions for everyone based on that sample. So for example, all the knowledge we have about the basic vitamins in our diet came from observations like the ones we (hopefully) learned about in elementary school: Chinese sailors getting rickets, children getting vitamin D deficiency in wintertime. [Read more about the scientific method here.]

The scientific method says this: You make a hypothesis (a guess) based on your observations. You test that hypothesis in a double-blind test, where the people involved don’t know whether they’re getting the real treatment or a placebo (for example, a sugar pill instead of a medication). Then you look at the results. Did the people in the control group react in the same way as the people being given the real medicine? If so, the “real” medicine is a failure. If not, it’s a success. A good scientist is perfectly happy to prove that her guess was wrong.

So here’s a real-life example: American communities used to be devastated by polio. Children and adults died or were maimed for life. Then Jonas Salk developed a vaccine for polio. It was tested on a group of people, who were then compared to a group that didn’t get it. Amazingly different results: the vaccine worked. Soon practically everyone in this country was being vaccinated against polio, and now we live in a time when no one who now has small children remembers the devastating effects of polio on their community.

Until 1999, the polio vaccine was “live” and thus caused some polio symptoms in a small amount of children (many fewer than were affected before the vaccine). Since then, all polio vaccines are dead and there have been NO cases of vaccine-induced polio in children in the United States. (Polio, however, does still exist in the world, and the amount of unvaccinated children in our community makes it possible that it will return here.)

So how does this relate to the great interest people have had lately in alternative medicine? The thing you need to remember is that science does not negate community wisdom, but it can test community wisdom, which is very important.

So a good example is St. John’s Wort, an old remedy for depression. It has been tested and retested. The studies don’t all agree. So should we ignore them and assume they’re wrong? No — this is just a good example of the scientific method in action. Some studies have shown moderate benefits from St. John’s Wort, many have shown no benefit, and just a handful make it seem as effective as modern anti-depressants. So it’s clear that scientists need to keep working on this to be more definitive. But on a personal level, it means that you might want to try St. John’s Wort and see if it works for you. And if it doesn’t, there are other medications available.

Community wisdom was not able to test this age-old remedy. Science is in the process of doing so.

We have a number of medical doctors in our community who also work with “alternative” medicine — a better term is integrative medicine because it can be a good partner to Western medical techniques. I wrote an article about Lucy Hu of 7 Branches. She is a Western medical-trained doctor who works as an acupuncturist. Rachel Abrams is an MD who started a clinic that incorporates various types of medicine. These people understand that an integrated approach is better for everyone.

Finally, I wanted to address the question of group vs. individual decisions. The scientific method is what’s used by our public health officials to make decisions like the recent one to try to get all children vaccinated against this year’s H1N1. (Read H1N1 information here.) Their decisions are based on which alternative makes the most sense over a large population. Sometimes those decisions seem wrong on a personal level, but that doesn’t change the fact that the decision was made with the larger population in mind.

All the recent studies done lately to analyze whether early childhood vaccinations caused autism are pretty clearly negative. Over large groups of kids, there is no evidence that vaccines caused problems. But that does not actually refer to any one situation. It is completely consistent with that result that one child’s autism could, in fact, have been triggered by vaccines. What the research says is for the larger group: It’s still safer for your child’s longterm health to get vaccinations. Saying that no child should get vaccinations because one child was hurt by them is like saying that no child should walk to school because one child was hit by a car while walking to school. It makes no sense, and if you made all your decisions that way, you might end up living in a padded cell.

I read a really great piece in the New Yorker about fear of vaccines and its roots in a swine flu scare in the 70’s. Definitely worth reading (if it’s still available when you read this). The writer says that some parents have been having “swine flu parties” like some do for chicken pox (another disease that can be debilitating or fatal).

The facts are out there if you want to know them. If you don’t, then you’re making your choice and you will live with the consequences, as we always say to our kids! And it’s very possible that there won’t be any consequences. The scientific method tells us that.

No matter what you choose on an emotional and personal level, the scientific method will be there to test whether it’s a logical decision for large numbers of people.

Posted in Health, Psychology.

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