Medicine: from scientific certainty to scientific humility

10/14/2021 6:04:53 PM


Medicine: from scientific certainty to scientific humility

Can just FDA approval or a physician's claim confirm that a vaccine is safe? In response to the people who consider the FDA sacred and without error, it is not bad to look at the history of this organization's faults. There have been many drugs throughout history that have shown hazardous side effects that have led to their recall after years or even decades of FDA approval. Drugs such as ranitidine were approved by the FDA in 1983 but were found to be carcinogenic in 2020 after 37 years of widespread global use [1]. Also, Rofecoxib was approved by the FDA in 1999 but was recalled by the FDA in 2004 after it was found to significantly increase the risk of heart attack [2]. It should be noted that these drugs not only were not approved in emergency status but also had a much clearer mechanism of action than mRNA vaccines. Based on these pieces of evidence, can we still say that these vaccines are safe and do not pose a major threat in the future? [3]
In addition, many groups in favor of the vaccines have a false and excessive trust in the opinion of a doctor or an organ, meaning that as soon as a well-known physician recommends a vaccine or claims that the complications such as future fertility dysfunction are not related to vaccines, these groups see the claim as an indestructible verse from the god. This is precisely what we call "authority bias." This error itself causes "confirmation bias". Which means that the FDA approval or a doctor's recommendation become so bold for the person that he/she is completely distracted from the side effects of the vaccine and only pays attention to the evidence that recommends vaccination. 
Please critique away from fallacies! If we are going to justify the unknown side effects of COVID vaccines over the future years by arguing that the side effects of the vaccines are less than being infected by the coronavirus, then it is better to say that our goal is simply to justify the vaccine in any way, right or wrong. Are we sure that these "unknown" side effects are all less dangerous than getting a virus? Is there any way we can claim that all the unknown side effects of the vaccine that will be revealed in the future are less risky than getting the virus? Definitely not; how can we judge so definite about the matter that we ourselves call it "unknown"?! So how do we defend the vaccine emergency license so confidently? With this way of defending the vaccines, it can be inferred that you consider practically any possible side effects for the vaccine! Revealed complications are increasing day by day, and those who agree with the injection of the vaccine, just to justify their opinion, consider them to be wrong content in cyberspace, without examining them a little without prejudice. Another charge that pro-vaccine groups make against us is that you have no scientific reason to support your opinion. Aren't articles and historical examples and pieces of evidence considered as science or proof? Or we just have to wait several years for the unknown and possibly terrible side effects of the vaccines to reveal so that we realize the mistake and the long-term consequences of our work.
Many philosophers are induced by the COVID-19 experience, the same as the other pandemics during history. This induction makes philosophers rethink the values of medical practice. Looking at the history of medicine, we see that it was inefficient more than effective. Also, reconsideration of standard protocols in biomedical research shows many defects about methodological flaws and conflicts of interest. 
Therefore, due to the existence of these drawbacks, we take a deep look toward the notion of "gentle medicine", formulated by philosopher Jacob Stegenga, that explains a form of medicine in which the intervention of physicians would be lesser. 
The prestige of modern medicine is founded by specific achievements called "magic bullets". Penicillin and Insulin are among the most important magic bullets. Looking toward the last 150 years, we see many developments in medicine, but magic bullets are considered exceptions instead of being a norm. For example, we can address statins, which were considered magic bullets, and many pharmaceutical companies generate huge profits through the sales of statins. But the reduction of cholesterol levels can lessen the risk of heart diseases relatively minimal, and by considering their drawbacks, in a cost-benefit analysis, they may show negative outcomes in terms of safety. 
It is important to know that few institutions give funds to researchers that fail to reject null hypotheses. And there is a lot of pressure for researchers to design positive-outcome experiments. As Richard Smith says, "medical journals are an extension of the marketing arm of pharmaceutical companies" (even if we phenomenon, but it has its pressures). This makes trials follow the way that companies benefit from. 
For example, among 56 trials that suppliers of NSAID drugs funded for arthritis, it was found that the number of studies that show unfavorable results for pharmaceutical companies was ZERO! and independent researchers report negative side effects 22 times more than pharmaceutical industry-related scientists, same as what we may see from vaccine producing companies that gain a huge benefit from selling COVID-19 vaccines in the era of a pandemic.
Many philosophers are induced by the COVID-19 experience, the same as the other pandemics during history. This induction makes philosophers rethink the values of medical practice. Looking at the history of medicine, we see that it was inefficient more than effective. Also, reconsideration about common protocols in biomedical research shows that there are many defects about methodological flaws and conflicts of interest. 
Therefore, due to the existence of these drawbacks, we take a deep look toward the notion of "gentle medicine", formulated by philosopher Jacob Stegenga, that explains a form of medicine in which the intervention of physicians would be lesser [4]. 
The prestige of modern medicine is founded by specific achievements called "magic bullets". Penicillin and Insulin are among the most important magic bullets [5].
Taking a look toward the last 150 years we see many developments in medicine but magic bullets are considered as exceptions instead of being a norm. As an example, we can address statins which were considered as magic bullets and many pharmaceutical companies generate huge profits through the sales of statins. But the reduction of cholesterol levels can lessen the risk of heart diseases quite minimal and by considering their drawbacks, in a cost-benefit analysis, they may show negative outcomes in terms of safety [6].
It is important to know that few institutions give funds to researchers that fail to reject null hypotheses. And there is a lot of pressure for researchers to design positive-outcome experiments. As Richard Smith says, "medical journals are an extension of the marketing arm of pharmaceutical companies" this makes trials follow the way that companies benefit from. For example, among 56 trials that were funded by suppliers of NSAID drugs for arthritis, it was found that the number of studies that show unfavorable results for pharmaceutical companies was ZERO [7]! 
and independent researchers report negative side effects 22 times more than pharmaceutical industry-related scientists, same as what we may see from vaccine-producing companies that gain a huge benefit from selling COVID-19 vaccines in the era of a pandemic [8]. 

Fast science!!
We know fast science with its two features that are the pace at which it is produced and disseminated and the impact it has on popular thinking and public policy. One example of fast science is the scientific work on the virus is growing exponentially: by early April, the number of scientific papers on the new virus was doubling every fourteen days. The number of page views at medRxiv has increased by a factor of one hundred since December.
Should philosophy of science engage with fast science?
An interesting idea was suggested because of so many unknowns, the precautionary principle. Of course that some scientists believe that the precautionary principle is ambiguous because we might be especially precautious about the harms of the virus, or we might be especially precautious about the harms of the lockdowns, but the precautionary principle itself is silent on how to balance the competing relevant concerns. it is a sort of intellectual silencing when a medical researcher, Didier Raoult, cites Feyerbend to disparage the 'dictatorship of the methodologists' when defending his non-randomized and non-blinded trial of hydroxychloroquine as a treatment for Covid-19.

Many philosophers of science are concerned with the demise in public trust of science, evident in debates about teaching intelligent design in classrooms or in mistrust of climate science. Conversely, many philosophers of science are concerned about excessive trust in particular domains of science, exemplified by, say, unreliable research on pharmaceuticals. Of course, it is perfectly consistent to hold that science is the best means to learn about our world, while also criticizing sloppy science [9].

By: Farbod Ghobadinezhad, Elham Ranjbar,  Mohammad Mohammadi,  and supervised by Dr. Hamidreza Namazi

 

References
1. https://www.rheingoldlaw.com/blog/2020/april/why-did-the-fda-approve-zantac-if-it-posed-a-dan/
2. Sibbald B. Rofecoxib (Vioxx) voluntarily withdrawn from market. CMAJ. 2004 Oct 26;171(9):1027-8. 
3. https://www.drugwatch.com/featured/misplaced-trust-fda-approval-concerns/
4. Stegenga, J. 2018. Medical Nihilism. Oxford: Oxford University Press.
5. Strebhardt K, Ullrich A. Paul Ehrlich's magic bullet concept: 100 years of progress. Nature Reviews Cancer. 2008 Jun;8(6):473-80.
6. Franco OH, Peeters A, Looman CW, Bonneux L. Cost-effectiveness of statins in coronary heart disease. Journal of Epidemiology & Community Health. 2005 Nov 1;59(11):927-33.
7. Rochon PA, Gurwitz JH, Simms RW, et al. A Study of Manufacturer-Supported Trials of Nonsteroidal Anti-inflammatory Drugs in the Treatment of Arthritis. Arch Intern Med. 1994;154(2):157–163.
8. Ebrahim S, Bance S, Athale A, Malachowski C, Ioannidis JP. Meta-analyses with industry involvement are massively published and report no caveats for antidepressants. J Clin Epidemiol. 2016 Feb; 70:155-63.
9. Stegenga j. fast science and philosophy of science [2020].

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