Avoiding Bias without Defeating Hope

Working with human subjects can be a little tricky, especially when they have experienced a life altering event such as spinal cord injury. It is hard to explain to people that the chances they will walk again or navigate through day to day life independently are low. Presenting a non-invasive therapy that has encouraging results in some studies, but non-significant results in others, to this population of people can pose a serious challenge. On one hand you do not want to give them a false sense of hope that the intervention being used will " cure" their partial/full paralysis, but you also do not want to defeat their hopes of functional improvement. The placebo effect as well as natural recovery after spinal cord injury pose a big challenge and can bias the outcomes of the study. We should also consider our bias as scientists when we observe changes in our participants, which can also potentially skew our data.

The article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917255/ addresses some of these concerns. One way to avoid bias in clinical research studies is to design the experiment in such a way that accounts for placebo effects and natural recovery. This means including baseline periods in which the natural progression of the functional recovery is monitored. In order to account for placebo effects, the therapeutic intervention used should have a placebo condition. For a lot of non-invasive stimulation technologies a placebo setting is built in, however a lot of participants are able to tell the difference between the sham and active settings. Unfortunately, I do not know of a good way to address this other than hoping for improvements in newer models.

A major challenge I face is remaining objective when it comes to the outcomes of the participants that I work with. I sometimes have to catch myself when a thought crosses my mind of  "wow, that person is improving a lot" or " this intervention technology does not seem to work as well as the other". Fortunately, other people are blinded to the intervention that are assessing that subsection of the data, but I believe that it would be useful for me to practice being as objective as possible when it comes to participant outcome. I don't want to be too objective and become a robot, especially since I have to interact with the participants. I want to give them hope for the possible and not the impossible, I want to base the things I tell them in facts and not fantasies. When subjects ask me about unproven novel "miracle" treatments, I feel it is my duty as a scientist to encourage them to be a part of a safer and regulated study. However, what if the non-significant, sketchy, unregulated study would have helped them? It's an ethical dilemma that I am faced with on a day to day basis.
https://www.vox.com/2015/10/29/9637062/media-hype-cancer-drugs

The Anatomy of Deceit

Like many great scientists before him, Dan Ariely was inspired to answer questions surrounding what he called “deceitful behavior” from a real life experience he had in the burn ward of a hospital. From his laboratory experiments on pain and reward at MIT and CMU, he concluded a few key points, which will serve as a framework for my reaction to the accompanying articles. These key points are as followed (paraphrased from Mr. Ariely’s own words):

1. Many people engage in deceitful behavior, but only do so a little bit at a time.
2. When people are reminded of their own morality, deceitful behavior goes down.
3. If someone is out-performing the rest of the group and part of the in-group, deceitful behavior increases.
4. When there is distance from a tangible end-point, deceitful behavior increases.
5. People have a hard time doing difficult tasks to prove they are engaging in deceitful behavior. 

Some of these points, when contrasted against the accompanying articles, brought up interesting questions for me on how and why dishonest science happens. For instance, according to the article written by Julia Belluz on supposed “miracle” drugs, there appears to be both the in- and out-groups who perform some level of deceitful behavior. That is, it is not only the doctors who use exuberant language to describe the results of certain cancer drugs, but also the journalists who are responsible for reporting on them.

                                                         

Can one then make the argument that journalists, like medical practitioners, occupy the same in-group? Or is it that the in-group and out-group have a symbiotic relationship where the in-group (doctors) can influence the out-group (journalists) and vice versa? In addition, Belluz cites immunotherapies, “the vanguard of cancer research,” as being the most frequently hyped cancer therapies. This addresses Ariely’s 4^th conclusion above: that is, a cure for cancer is far off in the distance, but scientific publications exist as an immediate means of professional currency. However, it exposes an interesting question for me: would cancer researchers not working in cancer’s “hottest field” feel the need to engage in describing their therapies with such hyperbolic rhetoric?

My gut tells me the answer to this question is no, especially considering the implications of curing cancer. I believe no matter where you end up, these overreaching descriptions of therapeutic results serve as a way to move the field forward, albeit not in a very honest way. This grandiose language exposes dishonest behavior by putting a proverbial red flag to heed attention to potential results. In Jared Horvath’s article, he suggests that these mistruths are simply a consequence of science, and that reproducibility, whether it can be achieved or not, must be fully disclosed. Furthermore, the inability to reproduce serves as a helpful caveat to moving the body of research forward. In many ways, Hovarth seeks to engage more researchers in Ariely’s 5^th conclusion: he hopes that researchers will undertake the difficult tasks of proving their deceitful behavior for the common good of science. This, I believe, is the future of scientific research -- engaging with our human errors.