28 April 2017

We need countervailing incentives in science

Dr Malcolm Kendrick writes about what he learned at medical school:
[N]ot only were certain key facts wrong, there seemed to be a co-ordinated effort to attack anyone who dared to challenge them. Tim Noakes found not guilty - of something or other, blog post by Dr Malcolm Kendrick, 26 April
Dr Kendrick picks two cases spanning forty years. The first was John Yudkin, the founder of the nutrition department at the University of London’s Queen Elizabeth College, who ' did not believe that saturated fat was to blame for heart disease, the idea at the centre of the diet-hypothesis. .... In 1972 Yudkin wrote the book ‘Pure white and deadly’ in which he outlined why sugar was the probable cause of heart disease, not fat(s). He was then ruthlessly attacked.' Dr Kendrick quotes from the (UK) Daily Telegraph:
Yudkin was “uninvited” to international conferences. Others he organised were cancelled at the last minute, after pressure from sponsors, including, on one occasion, Coca-Cola. When he did contribute, papers he gave attacking sugar were omitted from publications. The British Nutrition Foundation, one of whose sponsors was Tate&Lyle, never invited anyone from Yudkin’s internationally acclaimed department to sit on its committees. Even Queen Elizabeth College reneged on a promise to allow the professor to use its research facilities when he retired in 1970 (to write Pure, White and Deadly). Only after a letter from Yudkin’s solicitor was he offered a small room in a separate building. John Yudkin: the man who tried to warn us about sugar
Similar treatment has been dished out to Professor Tim Noakes, 'a very well-known proponent of the high fat, low carb (HFLC) diet, as a way to treat obesity and type II diabetes – and improve athletes’ performance.'

As Dr Kendrick says:
[A]ny scientist looking on gets a very clear message. If you say things we don’t like, we will attack you and drag you through court and make your life a living hell for three years. Now, that is how you silence people, just as they silenced Yudkin nearly forty years ago.
It's not really news that nutritionists and, indeed all scientists, are heavily influenced by whoever funds their research. But it is news of which we need constantly to be reminded. The stakes - the funding involved and the absolute number of people's lives involved - are high: perhaps higher than they have ever been. And what does need emphasis is that nobody under the current system has incentives to change things. Certainly not in ways that reward their success in doing so.

This is where Social Policy Bonds targeting the broad health of all a country's citizens could enter the picture. The bonds would introduce a source of funding that rewards people who improve society's health: not those who head institutions that purportedly improve health, or whose research budget depends on vested interests. Health Bonds would allocate funding purely on the basis of which approaches to improving society's health will bring about the most improvement per dollar spent. They would reward efficiency in achieving society's health goals. You would think that any multi-billion dollar government health budget would be doing that anyway. But, as in so much of the way policymaking is conducted even amongst western democracies, government and big business have interests that differ from, and are often in conflict with, those of ordinary people and smaller enterprises. They can get away with doing so by keeping our focus on nebulous and irrelevant arcana, such as Mickey Mouse micro-targets. Under a bond regime dissenting experts would be given a fair hearing. That would not only be in the interests of bondholders: it would be in the interests of society.

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