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The Enlightenment Returns

The Enlightenment Returns: Thus reads the title of an editorial in Science Magazine by Cornell physicist Kurt Gottfried and former head of the NIH Harold Varmus in the March 20 issue. On behalf of the larger scientific community that is breathing a collective sigh of relief, the authors want to acknowledge the new regime in Washington.Thus reads the title of an editorial in Science Magazine by Cornell physicist Kurt Gottfried and former head of the NIH Harold Varmus in the March 20 issue. On behalf of the larger scientific community that is breathing a collective sigh of relief, the authors want to acknowledge the new regime in Washington. Said President Obama: “promoting science isn’t just about providing resources—it is also about protecting free and open inquiry…free from manipulation or coercion, and listening to what [scientists] tell us, even when it is inconvenient—especially when it is inconvenient.”

In the President’s Memorandum of Scientific Integrity he called for new standards “designed to guarantee scientific integrity throughout the executive branch” and to ensure “that scientific data are never distorted or concealed to serve a political agenda.” This is as it should be. It takes care of the “in-house” problem that we had within the Executive branch during the previous Administration, where manipulation and coercion were rampant.

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The statement, however, makes the charming assumption that the studies served up by “science” are themselves value-free, which of course is not the case. It assumes that scientific reports are not biased, and that they don’t conceal a hidden agenda. This proposition has in recent years become very questionable indeed, with the increasing dominance of academic research by corporate funders that have very clear interests at stake. Additionally, we have the problem that individual scientists may also be personally either corrupt or simply too zealous to be appropriately self-critical in their work.

The problem of plain, naked scientific fraud is very difficult for the “system” to deal with. An analogy to the abuse issue among the priesthood may be helpful here. In retrospect one wonders why that issue was not taken in hand sooner by the Church hierarchy. The answer lies, I think, in the fact that the behavior of the deviant priests was so far outside of the paradigm that it could not be grasped. An appeal to the will of the offending priest to alter his behavior and to honor his covenants was clearly unavailing, as was the resort to “therapy.” That all took a long time to be recognized and acknowledged. If the hierarchy truly believes its message of the moral governance of one’s life, of the transformative power of faith, and of forgiveness and redemption, which it surely does, then one can begin to understand its blindness to what was actually going on.

Similarly, bald scientific fraud lies so far outside of the mind-set of the scientist that the research enterprise does not have good institutional means of dealing with it. Scientific fraud just doesn’t happen. And if it does happen after all, it’s a matter of the isolated rogue scientist. We don’t have a “rotten apple” phenomenon here that threatens to contaminate the whole barrel. No real institutional threat exists. In the scientific realm we operate with a belief in the self-correcting nature of the scientific process, and we assume shared fealty to the disciplines of the scientific method, a faith that may be just as touchingly naïve as that of the Church hierarchy.

Most likely, scientific fraud occurs on a continuum. We have slight indiscretions with regard to scientific rigor and probity at one end all the way out to wholesale data fabrication at the other. Incidence is probably broadly distributed as well. The problem is that the fraud—large or small—is very likely to be biased toward fulfilling the scientist’s expectations, and these expectations are likely to be aligned with the prevailing models. So the scientific process is just being helped along a little bit. If the result is to confirm what is already being expected and hoped for by the scientific community at large, then suspicions may not be aroused, and critical faculties may even be attenuated. On top of all the natural tendencies toward a confirmation bias an additional hidden variable may be at work. Scientific fraud is yet one more agency on behalf of the status quo in science.

Just as the Church for many years treated each case of sexual abuse as an isolated issue, we tend to treat each instance of scientific fraud as an isolated case. The possibility of a much larger, systemic flaw, was not considered by the Church for many years, and it is not being considered by “Big Science” now. And yet that’s probably what we have to contend with. With regard to issues such as vaccine involvement with autism, the fraud has become institutionalized. The institutional opposition to neurofeedback is another case in point. In those rare instances were fraud is apparent, the perpetrator should be held up to public opprobrium.

The Case Against Mark Nuwer
Mark Nuwer is a neurologist at UCLA who has been agitating against the reliance on standard QEEG-type of analysis in the discrimination of traumatic brain injury. His campaign has been ongoing for nearly twenty years. Most recently, he has been accused of misreprenting data to make his point, and from the court filings it appears that the evidence against him is pretty solid.

Instructions were given to Jack Johnstone of Q-Metrx, an innocent party in these proceedings, to analyze QEEG data in four different ways, only one of which was the conventional approach based on artifact removal prior to standard statistical probability mapping. In two of the runs, artifacts were to be left intact in the record. The results of those four different analyses on the same data set were then presented by Nuwer in court as if all were “legitimate” analyses that simply differed one from another as they might, for example, with different services analyzing the same data. The court was not informed that the different data sets were obtained under variable assumptions, most of which were contrary to standard practice. Three of the four traces are shown in Figure 1. (The fourth trace, being artifact-dominated, was identical to the first, and is not shown.)

Instructions were given to Jack Johnstone of Q-Metrx, an innocent party in these proceedings, to analyze QEEG data in four different ways, only one of which was the conventional approach based on artifact removal prior to standard statistical probability mapping.

The intrusion of fraudulent practices into this issue is doubly unfortunate because one’s tendency is to throw the hypothesis out with the fraud. If Nuwer’s case against statistical probability mapping (SPM) is fraudulent, then SPM must really be ok. There are, however, legitimate issues to be resolved with regard to discriminant analysis of the EEG for purposes of differential diagnosis. By making the case more of an absolute all-or-nothing proposition, Nuwer undermines the more subtle analysis of issues that must continue. Nuwer’s case against the use of QEEG in discriminant analysis has become an absurd caricature of the scientific process. It is hard to see how this will be cleaned up.

Science and the Courts
The legal history of the issue of discriminant analysis illustrates a larger point, which is that the courts are not a good way of resolving scientific disagreements. The tendency for people on all sides of a legal issue is for each to shore up the respective position to put the best light on it. The easiest means are by the selective presentation of data. The falsehood typically does not lie in the data themselves but in the withholding of other data that the court will know nothing about. If it is a challenge for scientists to be scrupulously correct with regard to data that support their fondest ideas, we cannot expect such probity to prevail in an adversarial setting.

The reason the issue of discriminant analysis spends so much time in court is traceable to insurance companies’ ongoing interest in fuzzing up the issue of traumatic brain injury. The big money, therefore, sits only on one side of the table. This is the second primary reason not to see the courts as a proper venue for scientific issues. Large financial interests can drag things out forever by the mere artifice of continually raising doubt about issues that are complex, and fraught with intrinsic uncertainties. This happened with the case against tobacco, and it happened with environmental issues generally.

Recently the proposal was made by the Chamber of Commerce that a Scopes-type trial be mounted on the issue of global warming. What a circus that would be. In the actual Scopes trial, let us remember, the issue to be resolved was not the validity of the theory of evolution but rather the question of whether Scopes violated Tennessee law in teaching the subject. It turns out that he had, and he was duly found guilty. The larger scientific issue of evolution is not something that a Tennessee court, or any other court, should ever agree to take on. The same goes for global warming.

The suggestion of a trial is surely badly motivated. Such a trial would continue endlessly, which is just what Chamber members would want. It would postpone the day that they might have to take action against global warming. We are seeing here yet another powerful institutional bias in favor of the status quo.

We retain the fond hope that corporations are the source of innovation, and so we allow them wide latitude in our society. The largest enterprises, however, find it easier to deploy their innovative skills in protecting their turf. When it comes to true innovation, corporations usually just acquire it after the hard work is done on a small scale by the real entrepreneurs. Corporate innovation is called for to separate the inventor from his invention. The large corporation is more like an aircraft carrier that cannot be expected to redirect quickly. Its priority must be to protect itself by means of a large group of support vessels. In the real world, one of the support vessels is our court system. Long ago, the Supreme Court gave companies standing in the courts with all the rights of individuals. They have become the first among equals.

Resources:
Information on the ethical complaint can be found at the following link:
http://www.appliedneuroscience.com/NuwerEthicsComplaint.pdf

Siegfried Othmer, Ph.D.
www.drothmer.com

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5 Responses to “The Enlightenment Returns”

  1. Brian Pitcher says:

    Could you reference more details regarding Dr. Marc Roman Nuwer? My wife here in BC is fighting to keep her QEEG results to be admissable. Insurance company wants the results throw out court. My wife’s QEEG showed results with moderate brain injury. Also the other testing has proven she has cognitive problems, and issues regarding hearing. I have background in Criminology, but I’m not a lawyer just former researcher and retired from law enforcement.

    Anything would be appreciated …

    Reply

    Siegfried Othmer Reply:

    There is simply too much to say on this issue to be contained in a quick response that would fit this format. Please contact me directly for a more specific response related to your your wife’s situation. There is indeed much to criticize in the current state of QEEG analysis, and this is what Nuwer chooses to dwell on, as a presumptive paid consultant to the insurance companies. The problem here is the usual one of over-claiming. I would be among the first to criticize the segmentation between minor, moderate, and major traumatic brain injury on the basis of QEEG data alone. On the other hand, there is little doubt that standard QEEG analysis does reflect the status of disregulation that typically results from traumatic brain injury. It’s just not a one-to-one relationship. Deficits can exist that don’t leave obvious traces in the QEEG; and deficits can surface in the QEEG that do not leave the individual significantly impaired.

    QEEG data are clearly useful as supporting evidence if functional deficits are documented. It remains to prove, however, that a particular injury was responsible for the observed deficits. This is a huge loophole for the insurance companies because pre-trauma data are usually not available. It also happens to be true that most traumatic brain injury cases reflect the consequences of a sequence of prior traumas. Insurance companies take this one to the bank.

    The insurance companies are skilled at derailing cases such as yours, through the use of arguments that have just sufficient scientific and statistical validity to pass a basic credibility test. They are usually sufficient to get the case wiped off the judge’s calendar.

    But I assume that you are more interested in your wife’s recovery rather than in her compensation. For this purpose, nothing comes close to EEG neurofeedback, and even if the insurance company were to acknowledge your wife’s deficits, it would still not pay for the neurofeedback that she needs! You’ve got two battles on your hands, not just one. From the frying pan into the fire….

    Bottom line: your wife needs neurofeedback; do what you can along these lines, and abandon the project of trying to reform the nefarious schemes of insurance companies.

    Reply

  2. Alberta Anchen says:

    Could you please post more details regarding the Nuwer case – specifically, who made the ethics complaint, to whom, and what was the outcome? The .pdf file under the “Resources” link leaves out these important details.

    Reply

  3. The ethics complaint was made by Robert Thatcher, Ph.D., who tried to pursue the issue with several organizations including UCLA, the Academy of Neurology, and The California Medical Licensing Board.
    None of them were willing to pursue the claims Dr. Thatcher was making.

    One should not be completely surprised at this. We are dealing with a somewhat esoteric issue here, and the charge is being made against someone who is university-affiliated, well-published, and well-established in the field.

    Consider further just how well ethical complaints fare when ordinary misconduct is involved. According to Public Citizen, no state licensing disciplinary action was taken against more than half of the 10,672 doctors in the National Practitioner Data Bank (NPDB) who had at least one revocation or restriction of clinical privileges by their employers from 1990 to 2009.

    Of the nearly 6,000 physicians whose medical boards failed to take action for one reason or another, more than 1,000 were punished for “incompetence, negligence or malpractice;” 605 for providing “substandard care,” and 220 because they were deemed “an immediate threat to health or safety.”

    In the face of such collective inaction, the failure to move against Nuwer in this case is not unexpected.

    Source:
    http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/31288

    Reply

  4. Alberta Anchen says:

    Thanks.

    Reply

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