Sunday, March 16, 2014

A fraud, but not a villain. What about us?

Bruce Ramshaw, a surgeon from Daytona, FL, has spent a lot of his career exploring the ramifications of complexity science.  In this article in General Surgery News, he offers some observations worthy of attention.

He starts with a story:

In September 2010, a 44-year-old academic superstar was named dean of the Tilburg School of Social and Behavioral Sciences faculty at Tilburg University in Tilburg, the Netherlands. Just one year earlier, this acclaimed social psychology researcher, Diederik Stapel, received the Career Trajectory Award from the Society of Experimental Social Psychology. Stapel moved to Tilburg University in 2006 and started TiBER, the Tilburg Institute for Behavioral Economics Research. By the pinnacle of his career, Stapel had authored and co-authored dozens of papers, some published in the most prominent journals, such as Science. The problem was that Diederik Stapel was a fraud. For more than a decade, Stapel made up data for his studies, regularly hoodwinking his co-authors, colleagues and students alike. Why would a recognized brilliant student and young researcher do this? He was clearly beyond capable of producing valuable scientific research. Why would he risk so much when he had the ability to do the work honestly?

The New York Times gave the answer:

In his early years of research—when he supposedly collected real experimental data—Stapel wrote papers laying out complicated and messy relationships between multiple variables. He soon realized that journal editors preferred simplicity. “They are actually telling you: ‘Leave out this stuff. Make it simpler.’” So, Stapel decided it would be better for his career to make the results of his studies simple to understand. He chose to make things up because that is what the editors, and presumably the journal readers, wanted to read. 

Bruce brings the lesson closer to home:

Although blatant fraud, as in the case of Diederik Stapel, does exist, it is not very common. A much more common problem in medical research is that the simplistic conclusions of published studies do not completely make sense when tested in the real world of patient care. Our traditional clinical research methods seek to prove or disprove a hypothesis to produce generalizable medical knowledge: that is, scientific medical truths that will apply to most (or to average) patients. Complexity science shows how incomplete this kind of thinking is when applied to the real (complex) world of patient care. Patients bring variability into the process and local variables make processes different in different clinical settings, even when the same disease is being treated with the same test or treatment.

We are a major part of the problem when we do not understand the complexity of the tests and treatments we prescribe and recommend. We need to evolve beyond our simplistic understanding of the results and application of medical research and apply a much more complete understanding of our world.

For essentially every test and treatment we have in health care, there are basically three subpopulations of patients who undergo a test or receive a treatment. First, there is a group that benefits from the test or treatment, but there is also a group that does not benefit (this is waste in our system), and finally, there is a group of people who are harmed by the test or treatment (directly or indirectly). Until now, our simplistic thinking has allowed us to rationalize that the waste and harm was just a necessary evil to help those patients who benefit from a test or treatment. Who could argue that a few unnecessary mammograms are justified to save a woman’s life? But complexity science argues, and the data from the use of vaccines and more than 30 years of screening mammography have shown, that it is not so simple and we are perpetrating a degree of waste and harm in patient care that is not sustainable and not ethical.

He concludes:

Diederik Stapel was a fraud, but he is not a villain. The villain in our world is not a person or an organization. The villain is our lack of understanding of complexity. Stapel’s desire to seek success by accommodating the desire to read simple results of complex biologic processes is the fault of no one individual but the fault of all of us who participate in the application of biological sciences.  

When we gain a more complete understanding of health care and our world, we will not only not allow simple-minded efforts like that of Diederik Stapel to achieve undeserved rewards, but we will also begin to address the waste and harm that is caused every day in our system that results from a much too simplistic understanding of how we care for patients and how we try to improve patient outcomes.

1 comment:

Anonymous said...

This is ridiculous, Stapel didn't falsify data to avoid complexity, were that the case he would have collected data and selected only that which fit a theory. Stapel falsified data because it was easy and made him successful; there was no grander goal than his own advancement. Avoiding complexity is merely his excuse du jour, Stapel is a fraud AND a villain.