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OPINION AND ANALYSIS | 15-05-2023 11:02

Research and behaviour: Gaps between production and the use of scientific evidence

There were documented warnings of an increasing likelihood of emerging infections or reinfections in a prevailing context of ecological and demographic changes.

From an epidemiological perspective, the appearance of SARS-CoV-2 did not surprise public health specialists. There were documented warnings regarding an increasing probability of emergent infections or reinfections. In a prevalent context of ecological and demographic changes, we place people in close contact with multiple viral and microbial variants facilitating a probable spread outside their natural hosts (1).

With a strict epistemological vision, it was possible to observe many erroneous initial statements regarding SARS-CoV-2 since they were based on the very different etiological characteristics of the SARS-CoV-1 and MERS (with mainly zoonotic transmission from dromedaries and very scarce person-to-person contagion).

A critical qualitative review of observed behaviours should stimulate an improvement of adaptive conditions under crisis and uncertainty. Precision and accuracy notions as central values ​​of a rational science demand a necessary review of eventual cognitive biases and dissonances hindered in early, exhaustive and critical analysis of new evidence partially refutational of certain prevalent biomedical knowledge.

Simon (2) stated that the critical clinical circumstances of the SARS-CoV-2 Pandemic generated exhausting therapeutic demands that were met through trial and error; in the same way, he states that epistemologically based instructive guides or norms for clinical observation and rapid update of the prevailing medical knowledge were absent.

Several early clinical recommendations were inappropriate (not generalised use of face masks, assumption about the need to aspirate a large number of virions from carriers with obvious symptoms, non-contagiousness of asymptomatic patients and children, non-recognition of multiple factors of transmission of the virus by aerosols or other fomites) and that lack of clarity implied challenges not only for clinicians but also for philosophers of medicine (epistemologists).

In this context, no clear instructions regarding the best methods to collect verifiable information based on effective clinical practice have appeared, and how, based on this, generalisable and applicable medical knowledge should be rapidly updated. This argument explicitly describes the existence of gaps, not only in the operational knowledge of applied sciences such as medicine, but also in the conceptual or theoretical frameworks that should govern them.

It is evident that biomedical research has formulated explicit methods and guides for the acquisition of scientific information in contexts of basic and applied research and in randomised clinical trials (hypothetical-deductive information, although not nomological). In the latter cases, this is due to the fact that the conclusions or relative evidence are mostly based on observed empirical phenomena (reaction or non-reaction to a certain molecule), without sufficient capacity for the construction of explanatory hypotheses of the registered phenomena.

Fleck (3) brilliantly warned us that facts are distinguished from transitory theories by being something definite, permanent and independent of any subjective interpretation by the scientist; undoubtedly the critical construction of the methods used to establish these facts constitutes the central theme of epistemology.

However, assessment based on some research can be inherently naïve, with the result that only superficial data are acquired, since the critical knowledge that we could have once had on the organic basis of perception has been lost; basic facts are taken for granted without being aware of our own participation in the mechanisms that can condition the perception of the explicit and implicit circumstances that define them.

In the maelstrom of therapeutic activity it is not counted or perhaps as some argue it has been lost, the original meaning of translational medicine that generates information from daily empirical clinical practice (pseudo-inductive information), its capture, contrast and of course generalisation.

In different previous investigations we have evaluated impacts and the health applicability of behavioural knowledge in the face of cognitive biases and dissonances such as: anchoring (overestimation of acquired knowledge and little receptivity to new information that may question it), selective perception (by not recognising that the way in which we process the information may be conditioned by perceptual preconceptions) and, more seriously, confirmation bias (when we unconsciously distort new information in order to confirm what we already know) and how these elements cognitively affect many decisions of patients and healthcare providers.

The essentially reactive behaviour usually observed should lead to better paradigmatic planning, and so a reduction of the gap between production and use of scientific evidence in health decision-making, avoiding the adoption of conclusions without sufficient evidence that may support them.

 

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1. Morse S.S (1995) “Factors in the Emergence of Infectious Diseases,” Emerging Infectious Disease Vol. 1, No. 1 — January-March
2. Simon J. R.(2021). COVID-19 and the problem of clinical knowledge. History and philosophy of the life sciences, 43(2),52. https://doi.org/10.1007/s40656-021-00405-7
3. Fleck L. (1981) “Genesis and Development of a Scientific Fact,” The University of Chicago Press
 

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Martín A. Morgenstern

Martín A. Morgenstern

Dr. UBA, MBA y Bsc. Profesor e Investigador en Economía de la Salud.

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