The breakthrough

The presentation of science in the media is usually far more optimistic than other areas of reporting; in place of war and famine we have breakthroughs and astonishing discoveries. But the detail — the slow accretion of supporting data and the puzzling incompatibility of some results — is usually ignored. In effect, science stories are ‘edited’ (either by the journalist or by the scientist who talks to them) to give only the punch line. This fact profoundly affects the expectations that society has of its scientists and doctors. We are bombarded by images of miraculous healing by doctors, who are themselves informed by scientists constantly, and predictably, making breakthroughs. A patient who falls victim to a serious disease expects to be cured, not supported or monitored. But many can’t be. A recent ‘special’ on US public television examined the morality of providing (or not providing) extremely expensive health care in an atmosphere of constrained spending. Here, for a change, was a television program that showed how the mind-set of miracle science distorts health care decisions, pushing patients into treatments that were not appropriate. A 24-week-old baby who, even if she had survived, would have been massively brain damaged, was put through an exhausting and exorbitant ordeal of seven days of intensive care before the mother gave permission to “give up”. A terminal cancer patient went against the first set of medical advice to undergo a gruelling series of treatments with taxol, only to die after a very brief remission spent almost exclusively in hospitals. These people were making hard decisions, and they should not be blamed if their choices seem wrong; the chance of life, for yourself or a child, is so precious that it’s natural to clutch at straws. But a German doctor on the discussion panel argued that the choice to do nothing should be presented more forcefully, and applauded a doctor who had taken this course when his own father had pancreatic cancer. Would we be more accepting of disaster if we didn’t expect a miracle? We are not the masters of nature; unfortunately, until a terminal illness comes along, we’re happy to pretend that we are. Christopher Reeve’s education in modern medicine began with a horse-riding accident. The poignancy of the former ‘Superman’ becoming a quadriplegic ensured that, America being what it is, he was soon taking part in the ultimate of confessionals, the Barbara Walters’ interview. Although this had the potential to be cringe-inducing, Reeve was superb — brave, resourceful and just this side of sappy. His strength lay in his belief that he would get better, and indeed six months later he had made small but impressive advances. But Reeve is another victim of the prevailing belief in the wonders of science. He quoted statistics about the enormous costs of maintaining quadriplegics (in the billions per year), and then claimed that it would only cost around five million a year to come up with a cure. Once again Joe Public came away with the view that doing science is like building a house — you put the money and time in and you get the answer. Would that it were that simple. Reeve is not, of course, alone in his anger at governmental or scientific inertia. The opinion that scientists are deliberately neglecting HIV research, at first only expressed in a few gay newspapers, has spread to the major news media — presumably because if scientists were really trying, the disease would be cured by now. The dereliction of duty at the beginning of the epidemic was deplorable, but now the imperatives of economics and fame ensure that if a company can overcome the scientific hurdles, they will do so. How can we counter these misunderstandings? I am a firm supporter of translating our science so that it is understandable by our friends and relatives, a view championed by Andrew Murray in this column. But even as we act on these good intentions we all propagate small white lies that inflate the prospects for the applicability of our work. Nothing that we say is untrue, but we play down the low probability that the truth will emerge in the way that we predict. This problem is particularly acute in the biological sciences, for it is here that the tolerance of work that is just plain interesting is lowest. It is accepted wisdom that everybody is interested in whether the universe will one day collapse, and where anthropology’s equivalent of Adam and Eve lived. No one expects either of these findings to affect their daily lives. And yet all biological studies are meant to contribute to the great medical miracle of the 20th century. We should not be afraid of explaining that our work is fascinating and true, with, perhaps, no other justification. We must make it easier for journalists to give a more complete and complex story, which means access to the messiness as well as the beauty. An increasing number of journalists are willing and able to write the story of the science, rather than of the breakthrough; an article by Jesse Green in the Sunday New York Times (explaining why HIV vaccines may be inherently unworkable) is one recent and notable example. There are many wonders of science ripe for publicity, and not all of them are sound bites.