More on the sociology of science

Last week I wrote about a recent sociology paper that has revealed a significant social grouping in the US, which they call “Post-secularists”. I suggested that the most interesting thing is not so much the nature of the new demographic as the fact that it was only after someone changed the kind of questions being asked that the phenomenon become visible to science. Here’s another instance of how science cannot be separated from sociology.

You may have seen this story last week. Many news articles sensationalized it along the lines that it showed all the old dietary advice was wrong, and so fried fat-balls are good for you. The Independent, at least, represents the study better as saying that though the advice to reduce saturated fat has turned out to be right through many subsequent studies, there were insufficient scientific grounds in the 60s and 70s for issuing guidelines to that effect.

Now, as someone who became a mouthpiece to many thousands of patients for such guidelines throughout my medical career (which began in 1976), this raises questions that nobody seems interested to answer, and particularly why, given the poor and contradictory studies available then, they became firm guidelines at all. To both researchers and readers now, I suspect no answer is required: those were the Olden Days, when people didn’t really understand science. But that’s nonsense, because the medical profession was every bit as scientifically aware, or unaware, as it is now, and that suggests problems in the past ought to prompt serious questions about the present.

I well remember reading, as a newly-qualified general practitioner, not the original papers themselves, but the host of professional educational material based upon them. These, of course, were written by leading research cardiologists who specialised in the field, had studied the data, and were the very people who were behind the guidelines being issued. And, as you can imagine, the kind of thing they wrote was, “The body of evidence implicating dietary saturated fat in cardiovascular disease is now impressive (refs. vi,vii,ix,xii), and recent work also demonstrates the effectiveness of increasing the proportion of dietary polyunsaturates and carbohydrates (refs. viii, x).” Which of us lowly family quacks was going to argue with that?

Now you must understand that working clinicians, especially general practitioners, usually have neither the time nor the expertise to evaluate original research – speed-reading snatches of the growing stockpile of BMJs is as good as it gets. In later years I learned from an excellent professor of therapeutics just how poor, and/or poorly interpreted, some of our major, policy-changing, research is. But nevertheless in those far-off days clinicians were an opinionated bunch and inclined to treat the latest findings with a pinch of salt (until salt went out of scientific fashion again a few years later). Even I (can you imagine it?) was already somewhat skeptical about the contradictory medical evidence I was being fed, and the very first humorous article I had accepted by World Medicine in 1981 reflects that.

And so in those days, whatever guidelines might have been issued either by official government agencies, or in the medical literature, were implemented enthusiastically, tentatively or not at all according to the judgement of individual clinicians. And that means that in the cases where the research was not just insecurely-based but plain wrong, there was a fair chance a lot of patients would be spared harmful interventions.

Nowadays things are very different, at least in the UK. When I last worked in the NHS, the latest version of my contract awarded brownie-points, directly linked to remuneration, for evidence that my patients had been given (and in some cases had complied with) the official guidelines on a whole range of matters including, of course, diet. In other words, there were sanctions against not following the “evidence-based” policies, and the independent mavericks of my youth, unless they knuckled under, were financially penalised. It would be even worse now, as regular professional revalidation has been introduced, and doesn’t take kindly to independent thinkers.

And so it’s extremely fortunate, isn’t it, that Science has now come of age, and that governments only ever issue guidelines that reflect the best possible research, unlike the 1970s when guidelines were based on … the best possible research. But just imagine a scenario (impossible I know, in this enlightened age) where a doctor with a strong background in research, like my professor of therapeutics, makes a point of digging into the original papers, in the way the writers of the study in the Independent article did, and concludes that the guidelines are inadequately or wrongly-based? Will he buck the consensus and lose income (making very little difference to his patients, who will get the official advice from elsewhere)? Or will he shrug, play the box-ticking game and retire early, as I did?

Now, regarding the matter of dietary fat, I’m in no position now to know the truth. But apart from the known harm of the 1970s advice in diverting attention from other dietary issues like sugar consumption, I am slightly suspicious when people say that all is now well because many studies support the policies that were introduced on inadequate grounds then. That’s especially so in the light of recent (post-retirement for me) British Medical Journal articles like this and this. For a start I want to know why they were introduced if it wasn’t because of the weight of evidence? I seem to remember, back then, reading National Geographic Magazine adverts pushing brands of healthy polyunsaturated margarines and cooking oils. There couldn’t have been any commercial interests involved, I suppose?

Be that as it may, there are some general influences that might well have affected subsequent research. One of the most important is that the first batch of papers on saturated fat, the first major work on diet and heart disease, had what one might call a “founder effect”: it set the paradigm within which science operated. In genetics, one finds that the indigenous settlers of a new territory, though perhaps only a few people, have a disproportionate effect on the genetic makeup of the later population. In the UK, for example, the first two waves (eastern and western) of post ice-age settlers still account for far more of our genetic makeup than the waves of invaders and immigrants since, however numerous or murderous of natives.

And so in an analogous way that early fat-damning research also set the agenda for many of the subsequent studies in several ways. For example, it alerted the research interest of the drug companies, who might make big money from cholesterol-reducing drugs. Food manufacturers, in contrast, would not be so likely to sponsor research that might well involve them in costly changes and damage to reputation, except for those which had cornered the market in polyunsaturates.

With that background, any studies that showed a negative correlation between fat and disease would be both commercially uninteresting (and hence not be published by pharmaceutical corporations) and scientifically dull – in a burgeoning field, you won’t make your name by publishing studies with inconclusive results, when others are showing a strong and world-changing correlation. Remember that this was occurring just a couple of decades after the link between smoking and lung-cancer was found: public health crusading was in the air. And so it is hard to believe that, given the “founder effect”, commercial interests, developing scientific consensus and, finally, popular interest and fear, there would not be some kind of natural selection of research that scratched where society was itching. This, of course, is going to affect even the big meta-analyses that underpinned the prescriptive goal-setting in my later career. You can only compare what has been published, and not what has been binned before release.

So although I am very willing to shrug and accept the possibility that low-fat yoghurt and olive-oil are better for me than butter and lard, having now been indoctrinated by a lifetime of my own ill-founded propaganda, it would be interesting, I feel, if the team that did all that digging on the research of the 1960s and 1970s repeated their labours on the later studies that have endorsed the original hypothesis.

The public are surely fully justified in what sociologist Steve Fuller calls their “prot-science”, refusing to give credance to today’s wisdom because of the repeated overturning of the old “settled knowledge” that has done them, and their families, actual harm. Scientific knowledge has always reflected social trends, and has always undergone its paradigm shifts as much from those trends as from any new evidence.

Neither the public, nor I, find much reason to think the real world of big science has changed that much over their adult lives.


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About Jon Garvey

Training in medicine (which was my career), social psychology and theology. Interests in most things, but especially the science-faith interface. The rest of my time, though, is spent writing, playing and recording music.
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8 Responses to More on the sociology of science

  1. “Butter and honey will be his food, when he is old enough to make a decision between evil and good.”
    I guess Jesus wouldn’t have known about modern research and the evils of fats and carbohydrates.

  2. Avatar photo Merv Bitikofer says:

    I wonder what balance there may be between fats and carbs is in locusts. Whatever the answer to that is, my curiosity on that will remain … curiosity alone. Maybe with enough honey …

    • Avatar photo Jon Garvey says:

      A good bit of protein in locusts, Merv – big wing muscles. Probably best fried, I’m told, which would bump up the fat content – but don’t use olive oil, which becomes carcinogenic when heated. I have to say I dissected them but stopped short of cooking them.

      Reminds me of a sketch I was in once in which John the Baptist, talking to a disciple, says, “Would you like a locust? Go lovely in sandwiches. Here, have a crunch….”

  3. pngarrison says:

    Jon, I remember getting a laugh from the Woody Allen movie Sleeper. When he wakes up far in the future and gets around to telling them of his ’70s hippie biases about food, they say, “Oh, that stuff was disproved long ago. We know now that the key to long life is to eat a lot of chocolate sundaes.”

    The tendency to conservatism among doctors sometimes protects patients, but sometimes it delays something useful getting into practice. I gather that there was quite a bit of resistance in the ’80s to the discovery that some ulcers were due to Helicobacter. We had all been told in med school that no bug could live in the stomach. My brother got over his ulcers (probably) because he had chronic bronchitis and the antibiotic therapy at least stopped the ulcers. When I told him about the new discovery, he told his doctor, who hadn’t even heard of it yet.

    When I was in grad school it was a common bit of lore that you couldn’t make antibodies to a denatured protein. And then someone tried it and it worked fine, although you would often get an antibody that only recognized the denatured protein and not the native form. That was fine for probing denaturing protein gels to see if your protein was there in small amounts. After that I always doubted the little practical bits that “everyone knew.”

    On your population genetic analogy, it is true that you islanders retain a lot of hunter gatherer autosomal variants, but the late invading Y chromosome variants largely took over from the hunter gatherer Y types, except in Scandinavia. I’ve been watching an Irish guy on a DNA genealogy site who got very attached to the older idea that the Y types that dominate the islands originated in Iberia during the Ice Age and then returned to northwest Europe as things got warmer. He really likes the idea that his Y chromosome was in Ireland 10,000 years ago, although the evidence of the last few years indicates that it didn’t arrive until the early Bronze Age with the migration of the horse riding Indo-European speaking groups. A pre-print came out last week with whole genome sequences of a bunch of ancient European samples, and it’s kind of interesting watching him grasping at straws to somehow preserve the hypothesis that he married. Marrying a hypothesis is usually a bad idea.

    • Avatar photo Jon Garvey says:

      pngarrison, I remember the news about Helicobacter and ulcers being quite smoothly accepted and welcome over here – certainly by me and the local GI guys. That was indeed a major breakthrough (though masked a bit by the naturally decreasing prevalence of Helicobacter infection).

      It’s hard to be sure what critical faculties I employed in my practice: on the one hand I tended to shun the latest highly-plugged wonder anti-inflammatories, which patients requested following press releases in the Daily Mail before there was any proper research info given to us. Usually that policy worked, in that when the serious side effects started creating scandals and general panic, I didn’t have to worry.

      On the other hand (still in the gastric department) I remember getting such a dramatically good response the first time I tried (very expensive) PPIs on someone with acid reflux that I knew a new era had dawned. Fortunately I’m still waiting to hear about more than small-print side effects.

      Your genealogy tale shows not only that Irish people are more determinedly Indigenous than most other races (see my own small contribution [with this] to Roscommon Garvey history, despite my ancestors’ having left 200 years ago), but also that being wedded to hypotheses is one of those non-scientific parts of science that makes a huge difference, especially if societal factors oversee the marriage. More on that, and on genealogy as it happens, in a post shortly.

  4. Apparently locust farming is on the increase as their nutritional value and acceptable flavour is becoming more widely recognised. Not available in Tesco yet.

    I cook with Olive oil.

    • Avatar photo Jon Garvey says:

      Peter, I cook with olive oil too, except when I don’t. The damage was probably all done with sugary tinned and processed food back in the austere fifties, so I reckon whatever harm I do now just lessens the risk of Alzheimers. I don’t smoke my olive oil, though I may be OK.

      Your point about commercial locust farming is amusing, in that I remember (also back in the fifties) a shop in Exeter that sold chocolate covered ants, fried grasshoppers and other abominations disguised as foreign delicacies (there weren’t even any Chinese restaurants then to provide balance). It all comes round again…

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