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Accepting the scientific method in theory, not in practice
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Here’s the truth: I just don’t like the scientific method. It’s not that I don’t believe it is absolutely essential, or that I don’t like science. Like so many others who graduated from medical school, I had the requisite chemistry sets and enjoyed many science courses. Even years of doing bench work during my 20s on immunoglobulins and T-cells were fulfilling, until I learned I had spent 2 years trying to confirm a published observation that turned out to be an artifact.
It is now clear to me, at this stage in my career, why I left that doctorate program in immunology to go into medicine and have never regretted it. As Danish philosopher Søren Kierkegaard wrote, “Life is lived forward but understood backwards.”
The source of this recent observation is my wife, who has put up with me for 33 years. Since 2009, I have had the honor and privilege of working with some very innovative scientists and clinicians in the field of collagen cross-linking. As a trained epidemiologist, my wife has begun taking an active role in data collection and analysis for some of our investigational studies.
In working with my wife, I have recently come over to her way of thinking, which is that, in general, clinicians do “doctor science” — a tongue-in-cheek term for what most of us, including those much more innovative than I, usually do in the world of clinical practice.
Roy S. Rubinfeld
Stifling growth
The scientific method of developing a hypothesis, freezing the technique and protocol at a point in time, and then using that same technique regardless of what new information becomes available runs antithetical to the way I and many other clinicians work. With every patient, I try to do things better. I believe most of us walk into the operating room with the hopes of being a bit better and smarter each time.
Of course, without the scientific method and its statistical analyses and masked, controlled standardized studies, we would still be applying leeches for treatment of “hysteria,” and much worse. However, this method is not how I like to learn. Instead, I like doing and then observing, constantly refining and improving. This process is not particularly scientific; rather, it employs clinical observation, intuition and a “feel” similar to athletic muscle memory.
In our corneal studies, after learning about early work on epithelium-on cross-linking, we found exciting ways to reduce pain, discomfort, haze, visual recovery duration, and the risk of infections or corneal melting. Had we frozen our techniques before we learned how to get epithelium-on cross-linking to work, these advances would not have been available to our patients.
Asking the right questions
We can all remember when, as medical students or residents, we would ask the patient questions, and then the attending physician would ask one simple question that yielded exactly what was wrong, as well as the best option for treatment. At the time, it looked to us like magic, but really it was a combination of experience and a “sixth sense” or (I hesitate to use these words in a professional publication) a hunch or intuition that was then verified.
This is clearly heresy, but I am not the only one to think this way, nor did I invent this approach. In the book, Blink: The Power of Thinking Without Thinking by Malcolm Gladwell, and many other texts on cognitive psychology and decision making, it turns out that the logical step-by-step algorithm of the scientific method may not yield the most accurate or fastest results.
Some of us simply prefer learning by doing, observing and then later on proving what we think we have learned. In fact, the publication in which this article appears may have a role in this process, as well. It often publishes articles based on podium talks, presentations, round tables and discussions with leading experts. These articles may not serve as rigorous scientific peer-reviewed literature, but they sometimes start or add to conversations and controversies that will later be evaluated using the scientific method. In a perfect world, these studies would be done by those who are gifted in and passionate about them; in other words, not by me.