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Dr. Vinod Kumar Gupta, MBBS, MD
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GUPTA MEDICAL CENTRE
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PHYSICIAN
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MIGRAINE-HEADACHE INSTITUTE
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S-407, Greater Kailash-II
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New Delhi-110048
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INDIA
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Telephone: +91-9911756123; +911-29213519
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Fax: +91-40537197
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E-mail:
[email protected]
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Research stymied by big ideas
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Joyner et al., have crafted a bold viewpoint1 that should resonate for long. Every
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big idea buds as a personal whim or correlation, and, gains traction by accretion
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of data, more often than not, without an overarching, generalizing, and defensible
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theoretical matrix or a well-structured theme. When any idea truly becomes big,
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it either gathers the garb of myths or randomized controlled trials (RCTs) or both
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and passes beyond challenge. Scientists, being human, follow fashion. Fashion,
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created by the belief of the herd, largely determines scientific output of any era.
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For any significant scientific discovery, however, the herd has necessarily to be
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proven wrong – and there goes the largest chunk of biomedical funding.
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Suspension of clinical disbelief and commonsense perpetuates the confusion.
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When science becomes abstract and the unchanging relation between variables is
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grasped, true progress is made. Fundamentally, research is frustrating.2 Major
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discoveries commonly come from unexpected sources. Science is not
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“democratic” but develops at random depending upon fortuitous conditions and
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an irrepressible idiosyncratic curiosity that cannot be assessed by biomedical
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grant authorities or be repressed indefinitely by the medical journal publication
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enterprise.
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Statistics have become vital for translation of grand ideas into RCTs. One of
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the goals at the level of grand idea-RCT nexus is to cling on to personal
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convictions at the expense of overpowering but contrary logic. More importantly,
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elimination of dissent becomes imperative. When all people think alike, how can
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there be progress? Next, “mathematization” of medicine through statistics has
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created dissociation between statistical and biological significances; it is not
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uncommon to grapple with data that cannot be reconciled with scientific logic.
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This limitation of RCTs is poorly recognized and never acknowledged. Meanwhile,
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the laisssez-faire for data accretion continues unabated, while the grand idea-RCT
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nexus, mired in rhetoric and reiteration, draws scientists farther away from
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scientific and clinical reality. Omission of readily available evidences is also an
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important mechanism for growth of such ideas. Finally, RCTs allow investigators
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to carry on research without concern for the basic sciences that envelop the
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entity or the evolution of a defensible theoretical matrix.3 The logic of advanced
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mathematics is itself incomplete.4 Like pun in words, mathematical patterns are
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pun in numbers; neither pun in words nor pun in numbers can ever be regarded
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as original in medicine.5 Scientific discovery is originally based not on number
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crunching, but on intuition, while intuition can only strike the prepared mind.
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1. Joyner MJ, Paneth N, Ionnidis JPA. What happens when
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underperforming big ideas in research become entrenched? JAMA.
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Published online on July 28, 2016.
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2. Kassirer JP. The frustrations of scientific misconduct. N Engl J Med 1993; 328: 1634-1636. DOI: 10.1056/NEJM199306033282212 3. Feinstein AR. Clinical judgment revisited: the distractions of quantitative models. Ann Intern Med 1994;120:799-805. 4. Sleigh JW. Evidence-based medicine and Kurt Godel. Lancet 1995; 346: 1172. 5. Gupta VK. Adaptive Mechanisms in Migraine [Editor]. Nova Science Publishers, New York. 2009.
