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The notion of truth in science and medicine, why it matters and why we must defend it
By Andreas Bikfalvi, University of Bordeaux, France: email@example.com
note: here is an updated version of this article provided by Andreas on 3/21/23.
« By denying truth and reality, science is reduced to a pointless, if entertaining game; a meaningless, if exacting exercise ; and a destinationless, if enjoyable journey » (Theocharis T, Psimopoulos M. Where science has gone wrong. Nature 1987 ; 329 : 4)
« Now the characteristic doctrine of modern irrationalists, as we have seen, are: emphasis on will as opposed to thought and feeling; glorification of power, belief in intuition « positing » of propositions as opposed to observational and inductive testing ». (Bertrand Russell, The ancestry of fascism. In praise of idleness and other essays. London : George Allen & Unwin 1936, 225 p)
The notion of Truth has different meanings including factual truth (affirmation according to the fact) and prescriptive truth (ethics, morals, etc.). They correspond to David Hume’s IS (factual) and OUGHT (prescriptive) Truths. I shall call them truth 1.0 (factual, IS) and truth 2.0 (prescriptive, OUGHT).
Truth 1.0 follows the strict guidance of the scientific method. Philosophers have described several approaches including causal inference, hypothetico-deductive method, inference of the best explanation, Bayesianism or causal networks. Truth 2.0 is represented by the values that one brings into the discovery path. One may contrast the writing of Bertrand Russell and Helene Longino. The former argues that values may negatively impact inquiry, while Longino argues that value free-research does not exist and we must cope with it. However, Longino proposes a very stringent value-system which will not allow certain research to be conducted. Indeed, there is a debate about how stringent the import of values into the sciences should be and thus how the OUGHT (truth 2.0) will impact the IS (truth 2.0.). The problem arises when truth 2.0 becomes hypertrophic, self-righteous, rigid and unconnected with reality, which marks a transformation into ideology (Social justice Ideology, SJI). Ideological intrusion into science and medicine is indeed a problem in Western Democracies. This is derived from scholarship originating in the humanities (Law, social science, branches of philosophy, etc.), which has been then transferred to Science Technology Engineering, Mathematics and Medicine (STEMM). The STEMM field was thought to be immune to SJI because of its rigorous methodology, but the hyper-specialization and absence of training in the humanities made it vulnerable to SJI. SJI has now been imported into all areas of STEMM, including the Academies (National Academy of Science USA (NAS), Royal Society of Chemistry (RSC), American Mathematical Society (AMS), etc.). Scientific publishing has also been invaded, with Diversity, Equity, and Inclusion (DEI) Statements as well as Citation Justice Statements (CJS). STEMM departments are now applying SJI criteria for hiring students and faculty. There are significant efforts with support from the American Medical Association (AMA) to introduce SJI in the form of Critical Race Theory (CRT) into medicine. Thus, SJI is present at every level in STEMM. The reason for these intrusions into STEMM and the amplification in the last 2-3 years is potentially due to “concept creep”, psychogenic contamination, Herd behavior and, for activists, strategical equivocation (Motte and Bailey Fallacy).
To reverse these tendencies, STEMM scientists need to have the courage to speak-up and defend free-inquiry and academic freedom.
The notion of truth is important for gaining knowledge, in particular in the sciences. However, this notion has become controversial. For Realists, truth is a crucial element in the quest for knowledge, while for anti-realists (e.g., instrumentalists) this notion is superfluous and devoid of any use.
I place myself on the side of realists and will herein discuss in more detail the meaning of the notion of truth as well as the perils that science and medicine are facing when truth is jeopardized, becoming a toy in the hands of ideology-minded social forces.
The definition of truth is wide when one looks at the Merriam-Webster Dictionary. The list is quite long and includes the following items: the body of real things, events, and facts; the state of being the case; a transcendent fundamental or spiritual reality; a judgment, proposition, or idea that is true or accepted as true; the body of true statements and propositions; the property (as of a statement) of being in accord with fact or reality; fidelity to an original or to a standard; sincerity in action, character, and utterance; in truth: in accordance with fact.
When one looks at these definitions, one can distinguish what is called factual truth and what is called the prescriptive and ethics-related notion of truth. This corresponds to David Hume’s what is (IS) and what should be (OUGHT). I shall call this Truth 1.0 (IS) and Truth 2.0 (OUGHT). I will first briefly elaborate on truth 1.0 and then deal more extensively with truth 2.0.
I. Truth 1.0
What are the characteristics of truth 1.0.? Truth 1.0 can be acquired through hypothesis-driven or data-driven inquiry in the biomedical sciences. Hypothesis-driven approaches have largely contributed to our present knowledge, but large-scale genomics/proteomics and metabolomics have come into fashion in the recent years. In 2010, in a Nature article (Weinberg 2010; Gollub 2010) Robert Weinberg and Todd Golub had an interesting debate about the hypothesis-first or data-first approaches. Robert Weinberg noted that the hypothesis-driven approach was/is very successful in knowledge acquisition, and that large-scale approaches have not yet led to the promised outcome. Todd Golub, on the contrary, maintained that the data-first approach will ultimately become mainstream, which it surely has over the past decade. However, even data-driven approaches will never escape hypothesis-formulation and even at the initial stage of the research, some hypothesis is already required. Thus, the two are complementary.
A number of ways (procedures or “methods”) have been described by philosophers of science for gaining knowledge and ultimately “truth”. These include: Classical causal inference, Bayesian statistics, error statistical approach, inference to the best explanation (IBE) and causal network building (Weber 2018, Pearl, 2008). I will not elaborate in more detail on these knowledge-gaining procedures, and the reader can refer to existing literature on the subject.
Another point is the notion of provisional truth in biomedicine and biomedical research. Thomas Kuhn formulated the concept of paradigm and scientific revolution but he ultimately had a relativistic outlook since he did not hierarchize between more recent better knowledge, which is closer to truth, and older knowledge that has been upset by the new knowledge (Kuhn, 1962, 1970). An equivalence for a specific epistemic setting is postulated for a given knowledge. However, this cannot apply, in my opinion, to the biomedical domain. For example, there is no equivalence in the truth value between Galen’s theory of blood vessel function and the circulatory theory that has been developed by Harvey. Many other examples of that sort can be given (The Cell theory versus Pfluger’s protoplasm theory).
Another idea is the existence of fluctuation between provisional truth and solidified truth, since provisional truth can solidify (but may not). Examples of solidified truth are: The cell as functional unit of life (“Cell Theory”, Schleiden and Schwann, 1846, 1848), Germ Theory (Louis Pasteur, 1877), Blood circulatory system (William Harvey, 1616, 1645), Oxygen and cellular respiration/energetics (Hans Krebs, 1957), DNA as the substance of heredity (Watson & Crick, 1953) or mRNA as unstable intermediate for protein synthesis (Jacob, Monod, Lwoff, Brenner, Nierenberg, 1965-1968). Provisional truth, however, is the norm. No claim should be made at the beginning of a research project that the discovery will lead to definitive truths.
Ignaz Semmelweis represents a case study of Truth 1.0. He used a mix of hypothetico-deductive and inductive reasoning by eliminating unsound hypotheses and by providing supportive data for the causes of puerperal fever in favor of the existence of a single septic agent (which anticipated the germ theory of Louis Pasteur). His case was extensively discussed by the German American philosopher Carl Hempel (Hempel, 1966).
II. Truth 2.0
Truth 2.0 is related to a value system, which means how the beliefs and assumptions shared by society or a specific community (here physicians or biomedical researchers) impacts the scientific or medical practice.
Value Free or Value-laden Science
There are two positions which seem antagonistic: One in favor of value-free inquiry and the other in favor of value-laden inquiry. It is of course evident that a physician and biomedical researcher must have a personal minimal ethical framework, which for physicians is represented by the Hippocratic oath.
Bertrand Russell has argued that philosophical (“scientific”, note by the author) inquiry must stay value-free (Russell, 1956, 2007) and that introducing personal beliefs has and will harm the philosophical (“scientific” note by the author) enterprise. More recently, the value-laden viewpoint has gained prominence (For a comprehensive review see: Elliott 2020). In particular, Helene Longino (1990) has argued that value-free science is a myth and that belief and assumptions guide research.
Longino coined the term “contextual empiricism” to stress the presence of the value context or framework. This value-framework should be reinforced and enshrined in the scientific methodology to not allow, for instance, racist or sexist research (e.g., research that could potentially harm minority groups). This is problematic for a number of reasons. First, the value framework (also called the Overton window) may shift, and what has not been problematic may become problematic over time. Second, who (a particular group of peoples, organizations, the state, etc.) is imposing these values? When one looks at historical events, “value” systems may vary enormously and may have some very negative impact on research (e.g., Nazism, Soviet communism, etc.). Furthermore, value-bound research impedes the autocorrective mechanisms that are built into science when science is done freely. Racist science can easily be debunked by better and freer science.
The problem arises when value systems become hypertrophic, rigid, self-righteous and do not follow reality (Figure 1). Science then becomes a toy in the hands of ideologues and this will have dramatic consequences for scientific inquiry and society in general (such as Lysenkoism and famine in the USSR, etc.). Hypertrophic, not realty-bound value systems are not only a problem in authoritarian countries but also in western democracies.
Figure 1: The IS and OUGHT in science. Values have a role, but only within the personal, minimal value-framework. When the OUGHT gets hypertrophic, and rigidly and self-righteously projects onto a pseudo-reality construct, it transforms itself into ideology.
Recent emergence of social justice ideology in STEMM
The recent emergence of social justice ideology (SJI) is a case in point. SJI is represented by three types of intellectual “currents ”: Critical Race theory (CRT), the decolonizing movement, and gender/queer theory (Figure 2). These are derived from cultural Marxism (Gramsci, Lukacs) to a varying degree. CRT is a kind of Americanized and racialized critical theory (Horkheimer, Marcuse, Habermas, etc.) with K. Crenshaw’s intersectionality concept as an important appendix. The present-day decolonization movement was and is promoted by scholars mostly of African, south-American or Indian origin, and the gender/queer branch is derived from radical neo-feminism, which then became radical intersectional neo-feminism when blended with Crenshaw’s intersectionality concept. Scholars at universities, and especially law schools, have played a significant role in laying the intellectual groundwork for these movements, which are widely diffused in many branches of the humanities and especially the social sciences. SJI has been largely amplified by social media corporations (Facebook, twitter, etc.) and has penetrated all areas of society, the arts (e.g., antiracist Shakespeare.), education, private or state-run corporations, cultural and scientific societies, scientific publishing, etc.
Figure 2: The origins of present-day ideological intrusion into science.
Science, Technology, Engineering Mathematics and Medicine (STEMM) were initially thought to be immune to SJI because of their scientific, rigorous methodology. But this turned out to not be true, as SJI now has a firm seat in many scientific and medical institutions (Royal Society of Chemistry RSC, National Academy of Science (NAS), American Medical Association (AMA), American Psychological Association (APS), American Mathematical society (AMS), etc.) and in STEMM university departments.
The characteristics of the attack on science, and in particular on biomedical research and clinical practice, are three-fold (Figure 3) and include its epistemic foundations, politics and society, and praxis. This has important consequences which include: (1) the replacement of epistemic foundation by SJI scholarship, (2) The debunking of supposed racism and sexism everywhere in STEMM, (3) social conformity and obliteration of viewpoint diversity in STEMM (4) reduction of every health differential to these variables (racism, sexism), (5) introduction of SJI and especially CRT into syllabus for medical students (6) tailoring treatments according to CRT and gender criteria, and (7) canceling dissidents.
Figure 3: The characteristics of the attack on science and, in particular, on biomedical research.
Social Justice Ideology in scientific publishing
Scientific publishing has also been completely overtaken by SJI. Many opinion pieces are published with a flood of articles of mediocre quality in leading journals such as Science, Nature, Cell, the Lancet, the New England Journal of Medicine, etc. In particular, DEI statements and citation justice statements (CJS) are recent significant developments (Dworkin et al, 2020). Indeed, there has been a push in some sectors of STEMM for the promotion of DEI statements that are appended at the end of a publication. Authors declare, for example, that the work has a balanced sex ratio for non-human subjects, that some of the authors belong to specific minorities or are disabled, that support has been received to increase minority representation in science, that the list of authors include contributors from the location where research has been conducted, etc. (Ray, et al, 2022).
As for the citation diversity statements, authors declare, for example, the following (Ray et al, 2022): “We are committed to promoting intellectual and social diversity in science and academic scholarship and took this commitment into consideration while researching and writing this article. We actively worked to promote diversity in our reference list while ensuring all the references cited were relevant and appropriate. We have included some references to enhance diversity but have not omitted any references for this purpose. To assess the diversity of our references, we obtained the predicted gender of the first and last author of each reference by using a database that stores the probability of a first name being carried by a woman (gender-api.com). Using this measure and removing self-citations, our references contain 30% woman(first)/woman(last), 11% man/woman, 15% woman/man, and 44% man/man. This method is limited in that a) names, pronouns, and social media profiles used to construct the database may not, in every case, be indicative of gender identity and b) it cannot account for intersex, non-binary, or transgender people. We look forward to future work that could help us to better understand how to support equitable practices in science”. Thus, to achieve this, specific software is developed to screen citations for their gender/ethno-balance (Dworkin et al, 2020). The causal explanation of these differences is always bias, stereotypes, exclusion of minorities, hegemony (of white, cisgendered heterosexual men), and systemic sexism and racism (Zurn et al. 2022). There are statements such as “the story of science as an objective hunt for inalienable truth performed by lone genius white men has pernicious effects for….” or “many efforts exist already to contextualize scientific progress outside the dominant narrative of white masculine European triumph…” These statements reflect no gratitude to the men who have contributed so much to science, technology and medicine, and thus to human flourishing (men such as Semmelweis, Pasteur, Koch or Einstein).
A recent example of SJI in science publishing is the special issue on racism by the science journal Nature, which seeks to overcome science’s toxic legacy (Nature 2022). This issue, better called “Special Issue on Anti-Racism”, was coordinated by Melissa Nobles, a political scientist and chancellor of the Massachusetts Institute of Technology in Cambridge, USA. Nature in their introductory page displayed all we are accustomed to from the nova lingua of social justice in the line of many previously published articles by the same journal. In their own words: “Nature has played a part in creating this racist legacy. After the killing of George Floyd by police in Minneapolis, Minnesota, in 2020, Nature committed to becoming an agent of change, and helping to end discriminatory practices and systemic racism.” It not only deals with self-accusations of deeds of the past but also of the present (without specifying any of the present day “racist” articles they published). It is egregious self-loathing.
The introductory statement from the issue-editors and co-editors reflects their full commitment to anti-racism and social justice ideology. The articles published in this issue range from subjective accounts of felt racism to systemic racism, racism in computer science or in medical practice, and racism in UK research institutions such as in the Imperial college where Huxley (Darwin’s Bulldog) is displayed as a racist. This is a blatant example of presentism. Furthermore, physiological differences are used as a proxy for racism such as the measure of skin O2 levels, which of course is different in dark skin when compared to white. The omission of this fact in the past is interpreted as racism. Overall, the articles in this issue display what Carl Hempel would call the fallacy of affirming the consequent: a hypothesis is inferred as true when the test results support the hypothesis, which leads to confirmation bias.
Social Justice Ideology in the Medical Practice
A final example is the intrusion of Critical Race theory (CRT) into the clinical management. Michelle Morse, a chief medical officer at the New York city department of Health and mental Hygiene, states in a tweet: “Racism is the risk factor not race. We should consider race in order to advance equity. Non-white race and Latinx ethnicity are social risk factors for sever covid because of longstanding structural racism”. She thus promotes a true anti-racist approach to health management. In an article published in the Lancet where Michelle Morse is cited as saying that “We will never get to health equity without taking a race-conscious approach” (Samarasekera, 2022). The American Medical Association (AMA) seems to endorse this approach, see Webinars by the Center of Health Equity such as the following:
Importing CRT into clinical medicine is a blatant betrayal of the Telos of medical practice. No one should get near a hospital where this type of approach has been introduced.
Amplification devices for Social Justice Ideology
The amplification devices of the SJI are 3-fold: (1) concept creep, (2) psychogenic contamination and herd behavior, and (3) the motte and bailey fallacy (strategical equivocation) (Figure 4).
Concept creep relates to the extension of meaning of socially important harm-related concepts (Haslam 2016, Haslam et al 2021). Expansive concepts of harm problematize previously tolerated behavior and reflect a growing sensitivity to suffering and injustice. The expansion of the concepts may be horizontal or vertical. An example of horizontal expansion is the concept of micro-aggression (from the SJI textbook) and vertical expansion “racism” which encompasses racist attitudes, as well as systemic, structural and institutional racism.
Classical psychogenic contamination can lead to psychogenic epidemic where neurological symptoms or other pathologic symptoms may appear. Recent Tourette-like syndrome cases in a young population have been described as being provoked through social media (Kirsten et al. 2020). At the same time, SJI may lead to collective mass psychosis when targeting specific socially relevant phenomena in which group behavior is reinforced. Carl Jung writes in Symbolic Life (Jung, 1977) on the dangers of psychogenic epidemic the following: “Indeed, it is becoming ever more obvious that it is not famine, not earthquakes, not microbes, not cancer but man himself who is man’s greatest danger to man, for the simple reason that there is no adequate protection against psychic epidemics, which are infinitely more devastating than the worst of natural catastrophes.”
The Motte and Bailey fallacy is used by activists to strategically misguide well-intentioned people where a concept (e.g., racism) is used as bait and subverted from its initial meaning. It is connected to some extent to concept creep.
Figure 4: Amplification devices for Social Justice Ideology (SJI).
The notion of truth is important for the progress of the sciences and medicine. It has led to innovation and to the development technologies for the flourishing of mankind.
Science and medicine have come under attack, mainly from the left, by problematizing their epistemic foundations and achievements. In the past, attacks on science came principally from the right and this may happen again. I have a clear non-partisan standpoint and I am critical of both the right and the left. I am very much in line with the critics of SJI coming from the left (see: Neiman, 2023, forthcoming).
In this article, after describing briefly the meaning of the notion of truth, I tried to analyze the relation between value and science in detail and provide an explanation for the present-day hypertrophic, rigid, and not reality-bound value system and its ideological penetration into science and medicine.
I leave the final word to Bertrand Russell who wrote the following: “…..When any limits are placed, consciously or inconsciously upon the pursuit of truth, philosophy (and “science”, note by the author) becomes paralyzed by fear and the ground is prepared for a government censorship punishing those who utter “dangerous thoughts” – in fact the philosopher (“scientist”, note by the author) has already placed such censorship over his own investigations”.
More than 50 years after these sentences have been written, these fears have become again reality.
University of Bordeaux, France
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