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Sunday, May 20, 2012

Embracing uncertainty is the defining feature of Medicine and of all good Science

A front-page headline in yesterday's New York Times announces an apology to the gay community authored by an aging giant in the field of Psychiatry.

Dr. Robert L. Spitzer has retracted the findings of a study that he published in 2003 which evaluated the effect of "reparative therapy," a technique aimed at "reorienting" gay individuals to heterosexuality.  Although the methodology of this retrospective inquiry was criticized as deeply flawed by his peers, the key finding - that reparative therapy seemed to be effective in "curing" homosexuality in some cases - influenced the national conversation on gay rights in ways that were offensive and damaging to  the gay community.

For me, this retraction is important and relevant.  Most obviously, because it is welcome news to a minority that, despite progress on many fronts, still faces societal discrimination, especially from the religious right-wing. At another level, however, it says something about the way good Science, and good scientific Medicine work.

Despite the widespread use of the term "scientific certainty" to denote significant surety,  this use of language reflects a misunderstanding of the scientific method and the nature of scientific knowledge.  The opposite of "Science" is superstition, while the sine qua non of Science is what philosopher Carl Popper called "falsifiability."  (More on what this means next time.)  Suffice it to say that falsifiability means, among other things, that a scientific claim is, by definition, one which can be overturned with evidence or, in many cases, with a more careful analysis of existing evidence.

Which in turn means that the process is self-correcting in a way that dogmatic thinking is not. This may unsettle individuals who perceive that the house of Medicine is like a pinball, ricocheting incessantly from one position to another.  The better metaphor, however, is probably that of a seagoing vessel guided by a skilled but invisible captain who counters the currents and shifting winds, bringing her direction through small but frequent corrections closer and closer to the desired course.  That course refers, of course, to verifiable truth; in the present case it means a clearer understanding of sexual orientation, not a concept retrofitted to accommodate someone's ideology but one arrived at through the collaborative scientific method, and for the benefit of all, regardless of health status, race, gender or sexual orientation.


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