Why “obvious” science matters

I’ve written a number of articles on new research in a variety of medical fields. Several have demonstrated findings that might be called “common sense” or “logical.” Some people responded that the results of the research should have been obvious, implying that the research may not have needed done.

For example, I posted some research on bullying that showed that there were lingering effects on those who were bullied. The effects were still felt some forty years after the initial bullying, in some cases. Were the results logical? Yes. Did that mean that the research didn’t need done? No.

In another story, I presented information from research that showed that children can do quite well in non-traditional families. Again, to many of us, that result was plain as day. Unnecessary research? No. Why? Because, sometimes what is logical and makes common sense simply isn’t accurate.

Let me give an example from medical history that shows what should be “obvious” and correct, yet isn’t.

Until about the late 1970s, heart attack patients were treated differently than they are today. When someone had a heart attack he was treated in the hospital. Often after a long inpatient stay, he went home where all exercise was forbidden. The majority of patients were placed on bed rest. It was thought that the weakened heart muscle should be rested. Working, stair climbing, sex, sometimes even walking to the bathroom, were not permitted. Then, gradually, over a period of weeks to months, the patient was slowly allowed to become more mobile. Perhaps being allowed to use the bathroom. Then allowed to walk for a little each day. Making very gradual progress.

Over time, cardiologists, physiologists and other researchers started to look at questions about exercise post-heart attack. What began to be seen was that exercise wasn’t necessarily a bad thing. That gradually increasing levels of exercise in many patients was beneficial. Patients who exercised regularly could actually reduce their risk of having a future heart attack. And cardiac rehabilitation was born.

Magnus-Pyke-shouting-Science-smPeople who had heart attacks, stent placements for narrowed coronary arteries, patients who had coronary artery bypass grafts (CABGs) and some patients with other kinds of cardiac disease, may all benefit. If we could pluck a cardiologist (or primary care doctor, cardiac surgeon, or nurse) from the 1960s and show them patients with recent heart attacks or cardiac surgeries actively exercising, those time travelers might develop their own cardiac problems just from that sight. They’d be conflicted by their logic, telling them that the weakened heart needed lots of long-term rest, versus what their senses were telling them about these patients walking on treadmills and using exercise bicycles.* Without that research, we’d still have cardiac patients propped up in bed for weeks. So the common sense approach that “heart attack—>weakened heart—>rest” may seem logical, but it turns out to be false in many cases.

There are other examples in medicine where the logical turned out not to be true, and where common sense didn’t provide the optimal treatment.

The same holds for other research that produces results that yield an “obvious” conclusion. Let’s look at the study on bullying that I mentioned above. Many of us may know someone who was bullied and is suffering long-term effects. Perhaps he has depression or post-traumatic stress disorder. We might jump to the conclusion that everyone who was bullied suffers for decades. But some people who were bullied didn’t have persistent negative consequences. That’s important. If we can find out why they didn’t, see how they coped, perhaps we can help those who are being bullied now prevent problems in their future.

The study on children in non-traditional families also got a result that was probably obvious to many of us. We “know” that those children who are adopted by LGBT parents are loved. But we need statistics to show this to those who don’t “know” it like we do. Perhaps the data from this study won’t change the opinions of the Regnerus supporters, but it is important for those who aren’t committed to one camp or the other.

It’s important to consider the research in broader terms. For example, with the bullying research we could ask, will further work lead to new information that can improve others’ lives?
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*Cardiac rehabilitation also includes information on diet and weight management, as well as an exercise program.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • ShelbySkinnerura321

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  • http://www.americablog.com/ Naja pallida

    Most vitamin deficiency conditions are pretty nasty, debilitating and ultimately fatal. But generally the solution is a fairly simple one – reintroduce what is lacking in the diet. Even if Goldberger’s fix didn’t work in all cases, it still wouldn’t have hurt to try.

  • 4th Turning

    This is a rather long but excellent layperson’s guide to comprehending the whole foil hat
    don’t confuse me with the facts muddle.

    “Take the example of the burgeoning raw-milk movement. So far, it’s a relatively fringe phenomenon, but if it spreads it threatens to undo the health benefits of more than a century of pasteurization. The C.D.C. calls raw milk “one of the world’s most dangerous food products,” noting that improperly handled raw milk is responsible for almost three times as many hospitalizations as any other food-borne illness. And yet raw-milk activists are becoming increasingly vocal—and the supposed health benefits of raw milk are gaining increased support. To prevent the idea from spreading even further, Nyhan advises, advocates of pasteurization shouldn’t dwell on the misperceptions, lest they “inadvertently draw more attention to the counterclaim.” Instead, they should create messaging that self-consciously avoids any broader issues of identity, pointing out, for example, that pasteurized milk has kept children healthy for a hundred years.

    I asked Nyhan if a similar approach would work with vaccines. He wasn’t sure—for the present moment, at least. “We may be past that point with vaccines,” he told me. “For now, while the issue is already so personalized in such a public way, it’s hard to find anything that will work.” The message that could be useful for raw milk, he pointed out, cuts another way in the current vaccine narrative: the diseases are bad, but people now believe that the vaccines, unlike pasteurized milk, are dangerous. The longer the narrative remains co-opted by prominent figures with little to no actual medical expertise—the Jenny McCarthys of the world—the more difficult it becomes to find a unified, non-ideological theme. The message can’t change unless the perceived consensus among figures we see as opinion and thought leaders changes first.”

    http://www.newyorker.com/online/blogs/mariakonnikova/2014/05/why-do-people-persist-in-believing-things-that-just-arent-true.html

  • 4th Turning

    Don’t who might be interested in following up on this item from last night’s nat’l news but considering, I think maybe some of my doubtfully overstated 1,000′s and your woefully understated “tens” should be made aware. It got as you can see just 2 minutes?

    http://www.nbcnews.com/nightly-news/cyberattack-crackdown-personal-computers-compromised-n109521

  • pappyvet

    Doc you are welcome to it , your articles are always well done and much needed.

  • emjayay

    Never heard of that disease. Googled it, got Wikipedia….yikes. There are photos.

  • Bose

    My grandpa had early retina-reattachment surgeries at Mayo after a head injury in the 1950s. The first failed; after the second, his head was stabilized with sandbags for a week. Knowing that Gramps would not slow down, the surgeon ordered him to rehab after — staying a week with the doc’s elderly but forceful mother (who only spoke Japanese). It was logical to the extent that the surgeons couldn’t take chances; both hope and skepticism ran deep about the developing procedure.

  • Zorba

    As a woman, I have always kind of thought (and I realize that that this is unfair concerning most men) that the smaller the dick (or the fear that their dick was inadequate), the more and the bigger the guns.
    Okay, okay, I know. Probably not fair at all.
    But still…..I do wonder about the basic psychology of bullies, and their adult counterparts. It seems to me that people (men, but women as well, because there are female bullies) who are secure in their own selves and their identities would have no interest whatsoever in bullying, and in fact would be repulsed by it. The bullying makes them feel better about themselves- they see themselves as “stronger” because they can push someone else around.
    Ah, well, just my own opinion.
    Perhaps a psychology or sociology thesis begging to be researched and written. ;-)

  • http://www.americablog.com/ Naja pallida

    I’m also reminded of Joseph Goldberger’s studies on pellagra. He proved it wasn’t an infectious disease and recommended a simple solution in 1926. Yet, southern states rejected it out of hand, basically only because they believed he was an “uppity Jewish New York doctor”, and continued to allow their citizens to suffer from an easily prevented, easily treated, condition for another two decades. Even when the obvious is pointed out, science still has a struggle to drag the willfully ignorant on board.

  • docsterx

    Exactly.

    I the Kochs, as children, could probably just have HIRED bullies to do their dirty work for them. Interesting question about the Tea Party members. I wonder if some were bullied and are now fighting back and others were, and still are, bullies? My gut feeling is that the same thing is true about the militant gun owners. Some were bullied and now want big guns to defend themselves with and others were bullies and have moved on from fists and stones to heavier firepower.

  • http://www.rebeccamorn.com/mind BeccaM

    One doctor had my father drinking buttermilk, two glasses a day. This was in the 1970s. Didn’t help.

    I think it was finally in the mid 80s they tried antibiotics and bam — instant cure.

  • Zorba

    Well, CRP levels, even if this is borne out, don’t have a damned thing to say about their subsequent behavior, well-being, or success in life.
    OTOH, I do wonder if people like the Koch brothers, Tea Party types, and their ilk were bullies when they were in school………..

  • docsterx

    “Millions”? “Thousands”? Maybe “tens.”

  • docsterx

    Thanks, Pappy. And I think your ” . . . the truth of water.” is a great phrase. If I were of a more conservative bent, I might just plagiarize that outright!

  • docsterx

    Exactly.

    Remember when patients were told to drink milk to soothe acid indigestion? No studies had been done, but it was intuitive that milk would have a soothing effect. Research showed that milk actually stimulates acid secretion in the stomach as much as alcohol does. There are lots of other, similar tales of the obvious not being correct.

  • docsterx

    No, I didn’t see it, Zorba, thanks.

    Interesting. Doesn’t seem to be much info on the bullies as they grow up, much more on the bullied. I do remember one study that showed that males who were bullies in middle school were much more likely to be arrested and jailed at least once by the age of 24. They were convicted of things like: vandalism, assault, theft and other crimes. They also had a higher rate of substance abuse than other males who weren’t classed as bullies.

    I wonder if this will be verified when additional studies get done? For now, it just looks like the bullies’ C-RP’s are lower. They don’t make a statement about their overall health or well being. I guess additional research needs to be done into this “non-obvious” science. ;^).

    I’m not crazy about the implications, either, if they’re borne out.

  • Zorba

    Hey, Doc, have you seen the recent results on the life-long effects of bullying itself on the actual bullies themselves?

    Childhood bullying has been linked to a number of physical and mental
    health effects, including lower self-worth, depression, and serious
    illnesses later in life. But until now, researchers had largely focused
    on examining these effects in victims of abuse, not the bullies
    themselves. This may soon change, as a long-term study published today in Proceedings of the National Academy of Sciences
    was able to demonstrate that “pure bullies,” people who have never
    experienced bullying themselves, do in fact face a long-lasting health
    effect from abusing others. As it turns out, that effect is actually
    beneficial — even when compared to people who aren’t involved in
    bullying at all.
    “Pure bullies had the lowest blood levels of C-reactive protein (CRP), a
    marker for inflammation,” says William Copeland, an epidemiologist at
    Duke University and co-author of the study. “This is kind of a
    beneficial outcome,” because CRP is a risk factor for a variety of
    health problems down the road, such as cardiovascular disease and
    metabolic syndrome, Copeland says. These findings therefore suggest that
    “the bullying experience was protective for the bullies.”

    http://www.theverge.com/2014/5/12/5710720/being-a-bully-may-be-good-for-your-health
    Not sure that I like these results, if they are substantiated by further investigation. In fact, I’m sure I don’t like them. :-(
    Ah, well.

  • http://www.rebeccamorn.com/mind BeccaM

    I’m reminded of the old ‘peptic ulcer’ — a disease that for many decades was treated with antacids, acid reducers, dietary restrictions, and often surgery. The cause was usually assumed to be stress and/or spicy foods. And basically the only cures were either removal or expecting the body to repair itself.

    Then someone finally paid attention to the groundbreaking work in the 1950s by Greek physician John Lykoudis who felt (correctly) there must be a bacterial component — and who apparently did treat patients successfully using antibiotics. This was later confirmed in the early 80s by Robin Warren and Barry Marshall who determined it was actually an infection by Heliobacter Pylori.

    They weren’t believed. So Marshall experimented on himself, drinking a solution of H. Pylori from a culture taken from a patient, and soon developed gastritis. The overt symptom of stomach pain faded after a few days, but apparently he still had the infection because one of the other symptoms is severe halitosis — which Marshall’s wife complained about, so he took the necessary antibiotics. Soon, he was completely cured.

    The ‘obvious’ science of peptic ulcers being caused by stress, excess acid production, and spicy foods was questioned. And doctors and scientists came up with the real answer.

    http://en.wikipedia.org/wiki/Peptic_ulcer

  • pappyvet

    Great one Doc. It is much like the child who is afraid to learn to swim.
    If then that person does at some time fall into the water they may very well drown. Not because the water is bad or necessarily dangerous but because they were not prepared with the tools needed to deal with the truth of water. They did not do their research. It was not necessary. Just stay away from it and everything will be fine.

  • TheOriginalLiz

    For centuries in Europe it was “obvious” and “common knowledge” that bathing was bad for you – opening the pores let disease in.

  • 4th Turning

    Scarpa’s car, the Bentley Continental Flying Spur, is pictured above next to its owner and what was built to be final resting place. It’s a gorgeous, high-end luxury vehicle — and also one of Scarpa’s prized possessions, perhaps second only to his $20,000 cockatoo, pictured here (with Scarpa and, of course, the car). Scarpa loved it so much he wanted to take it with him — to the afterlife.
    He had recently watched a documentary on ancient Egypt and, from there, learned that Egyptian pharaohs were regularly entombed with their favorite things. The theory was that these tombs acted as homes for their eternal slumbers and the trinkets sealed within ensured a regal life on the other side. Scarpa wanted to do the same, and posted the photo linked to above (the one with the cockatoo) to Facebook, announcing his intention to hold a funeral for his new car. When people doubted him, he posted a follow up picture — the one above, displayed shovel in hand, and car grave already in the process of being dug.
    This of course inspired outrage. The Daily Mail, for example, quoted a number of incensed people who saw Scarpa’s dream funeral as a mix of wasteful lunacy and unencumbered selfishness. Other reactions followed the same trend, with many wondering why a man with so much would not follow in his father’s philanthropic footsteps.

    http://nowiknow.com/burying-the-bentley/

  • 4th Turning

    Great work again. Day-dream you have a world-wide fan base of millions (okay 1,000′s).

    In early 1975, psychologist Ronald Hutchinson was proceeding smoothly with studies investigating why rats, monkeys, and humans clench their jaws. The work, bankrolled to the tune of $500,000 by several federal agencies over a decade, had placed Hutchinson at the forefront of research into the biological causes of aggression. But that April, a fiscally conscious legislator from Wisconsin skewered the research with a “Golden Fleece Award,”

    http://www.the-scientist.com/?articles.view/articleNo/10030/title/What-Proxmire-s-Golden-fleece-Did-For–And-To–Science/

  • bkmn

    A prime example would be the supplement industry. Billions (with a B) are spent on vitamins and other supplements in the hope that your health will be better. But some long term studies have not shown any benefit (and may show a possible detriment) to taking supplements.

    This billion dollar industry has an interest in maintaining the illusion that vitamin supplements are good for you.

  • Indigo

    Common sense is rarely common and what is obvious is not usually obvious to everyone until it’s been pointed out.

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