Writing as a Technology In Science and Medicine

Writing as a Technology In Science and Medicine Heather Graves English and Film Studies Office of Interdisciplinary Studies

Writing as a Technology • How is writing a tool or technology? • What do you use writing to accomplish? • In what ways can writing be hazardous or even dangerous? • What is the relationship between writing and reality?

Overview of this presentation • A Brief History of writing as a technology • Historical link between writing and medicine • Writing in medicine and ideology • Writing’s role in creating a “disorder” • Writing and Scientific Misconduct • Prevalence of Cheating in Science

Writing as Technology • Writing is a technology? • Isn’t it more a transparent medium for thought? • Scientist: do an experiment: “write up” the results? • “Write up” a patient’s medical history or chart? • Is writing just an adjunct/ follow-up to “real” work? This “Sample Write-up” by the Mineral of the Month Club is 10 pages long. Mineralofthemonthclub.org

Pre-Alphabetic Syllabic Writing Systems • Pre-alphabetic syllabic writing systems represented the physically heard syllables of language • Ambiguity of these writing systems were not well suited to developing unique ideas • Only specialists could read them Cunieform Source: ourdigitalform.pbworks.com

Alphabetic Writing Systems • Greek technological innovation was to use written symbols to represent an abstract unit of phonological structure—the phoneme • Phonemes (b, p, d, t, g, and k) exist in the abstract (to pronounce them, you need an accompanying vowel) • Writing system represented abstract phonological structure (not real speech), enabled the recording and reading of original text (i.e., literacy) Evolution of the Alphabet Source: lucian.uchicago.edu

Writing as a Tool for Education in Medicine • Many world cultures preserved medical knowledge, treatments, prescriptions in medical texts • Egypt, Hebrew, Ancient India, Greece, Rome, Islamic cultures, etc., all produced written texts documenting and preserving their culture’s medical knowledge Source: historical.hsl.virginia.edu

Medicine: Part of the Quadrivium in Medieval European universities • University graduates learned medicine from studying Greek and Islamic texts translated into Latin: Hippocrates, Galen, Avicenna, HalyAbbas, ar-Razi, Albucasis • Medicine was taught through lecture and disputation, supplemented with practice, apprenticeship, and dissection (guided by the same texts) • Not all faculties of medicine included surgery as part of the training Galen’s image of the heart c 1547 Source: scientopia.org

v d e Tradition, Writing, Observations, and the “Facts”: Vesalius 1560 Based on dissection of nine women “Vessel feeding the left ovary (e) originates in the renal artery (v) that carries uncleansed blood, while the right ovary is fed from the cleansed blood of the dorsal artery (d)” Belief: Female infants came from uncleansed blood of left ovary; males from the purer blood of the right ovary “Scientific theory” or tradition demanded Vesalius observe thisfactof female anatomy (From Nancy Tuana, The Less Noble Sex: Scientific, Religious, and Philosophical Conceptions of Woman’s Nature, [Bloomington, IN: Indiana UP, 1993], p. 140.)

Writing creates Ideology • Writing codifies ideas so they become knowledge • Permanent records of ideas (knowledge) can be correct or incorrect, but writing transmits them either way • Culture, history, tradition, and convention can ossify ideas so that even reality cannot dislodge them • Aristotle’s “science” or ideology of human anatomy was not officially discredited for nearly 2000 years

Patty Kelly, “A Rhetorical Analysis of Premenstrual Dysphoric Disorder (PMDD) in Canadian Newspapers.” • Analysis of newspaper coverage of PMDD in Canada 1986 – 2007 • “The creation of new mental disorders occurs in social and political contexts and medical classification carry tremendous rhetorical force” (83) • Examined 64 articles in 20 different newspapers over 21 years • Coverage began 1986 with proposed inclusion of PMDD in Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) (APA’s diagnostic tool and classification system for mental health professionals)

Implications of Inclusion in DSM • Kelly traces the controversial placement of PMDD in the DSM appendix in 1987 and its eventual movement into the manual itself as a full-fledged mental illness • In 1994 PMDD appeared in Appendix B and in the main body of the text under Depressive Disorder Not Otherwise Specified (with insurance code). • Dual placement occurred despite the PMDD subcommittee’s conclusion that “very little empirical evidence existed to support inclusion in DSM-IV” (86) at all. Source: qlinks.ca

Kelly’s Focus How is the mental illness PMDD constructed for newspaper audiences? How does the newspaper accommodations of expert language affect the representations of women diagnosed with PMDD?

Role of DSM and Newspaper Accounts • DSM emphasis on classifications based on empirical observations and scientific evidence establish it as “authoritative within psychiatry” (87). • “medical texts [such as the DSM] enact the values of biomedicine and facilitate the classification of persons” (87). • Kelly traces how discussions of PMDD become linked to discussions of PMS in newspaper accounts • In those accounts premenstrual symptoms eventually become “indicative of a pathological state” and women with premenstrual symptoms become “mentally disordered” (98).

Kelly’s conclusion to case study • Of her case study of PMDD, Kelly concludes that “the DSM standardized diagnostic criteria become persuasive not only for the professional audience for whom it was originally intended, but . . . the DSM [also]becomes persuasive for public audiences” (98).

Writing and Kelly’s argument • The act of recording symptoms is an essential part of a psychiatrist or physician’s work • A critical mass of recorded symptoms describing similar experiences in many people can transform the experience into a disorder or illness (of course, I simplify)

Writing as a Technology in Science • Writing establishes precedence for discoveries • Date for submission and acceptance appears on first page • “If you do the work but you don’t publish it, you might as well not have done the work.” –Researcher at NINT • Whoever publishes it first gets credit for doing it

Two Case Studies of Fraud • Compare the nature of the fraudulent science in each case. What similarities and differences do you see? • What actions were taken to detect the fraudulent activity? • In what ways might the researchers be said to have “used the system” to conceal their misconduct? • What makes the sources for these two reports credible or trustworthy (or not)? • How appropriate do you think the punishments were that were dealt out to these unethical researchers? • What are some of the implications of this unethical research for society in general?

Fraud in Scientific and Medical Research • 2008 – chemist in India, Pattium Chiranjeevi, was found to have plagiarized and/or falsified 70+ research papers in journals published 2004-2007 • 2011 –social psychologist, Diederik Stapel, was found to have fabricated data for over 100 publications over 15 – 20 years

Fraud in Cancer Research • Potti’s lies on grant applications (he claimed to be a Rhodes scholar in Australia: Rhodes scholars only attend Oxford) got widespread attention in 2010 • Anil Potti, Joseph Nevins, Duke University • 2006: New England Journal of Medicine reported they could predict the course of patients’ lung cancer using gene expression arrays • Predict which chemo would be most effective for lung, breast, or ovarian cancer • Biostatisticians could not replicate their results; found serious flaws in data

Fraud in Meterology “Johnson’s nonsensical claim rests on th[e] deliberate misinterpretation of temperature data” • Mark Johnson, meterologist for ABC WEWS-TV in Cleveland, OH • Jan 30, 2012: Misrepresented data to show earth has been cooling since 1998 • Brad Johnson published a rebuttal, claiming

Stem Cell Research Fraud • 2005 –Hwang Woo-Suk, Korean veterinarian • “Patient-Specific Embryonic Stem Cells Derived from Human SCNT Blastocysts, published in Science • “Unfortunately, the replacement wasn't much of an improvement, as some of the purportedly different images were found to partially overlap.”

Fraudulent: MMR-Autism Link • 1998 –Andrew Wakefield, Gastroenterologist, “Ileal-lymphoid-nodular hyperpalsia, non-specific colitis, and pervasive developmental disorder in children,” Lancet. • MMR vaccine triggered autism; Wakefield called for an end to MMR vaccination • Researchers could not replicate his findings; his research was declared flawed & article was retracted

Scientific Fraud • Brian Deer of Sunday Times found Wakefield was on payroll of group suing the MMR manufacturers (Wakefield had developed a vaccine he wanted the MMR replaced with) • 12 children were selected from the same clinic that fit Wakefield’s thesis • Medical records, diagnoses, and medical histories were altered to ensure symptoms of autism arose within 2 weeks of MMR vaccine

What is Scientific Misconduct? • “the violation of the standard codes of scholarly conduct and ethical behavior in professional scientific research” –Florence Colantuono 2009 • Intent to defraud is important (i.e., “guilty mind”) • http://www.experiment-resources.com/scientific-misconduct.html

Brief History of Scientific Fraud • Isaac Newton may have adjusted calculations to fit observations. • Gregor Mendel's results with pea plants were cleaner than what is observed experimentally, indicating that he might have changed the data. • Robert Millikan, in a research paper describing the charge of an electron, failed to mention that he eliminated some data points. • Louis Pasteur failed, in his studies, to cite that he used the vaccine against anthrax made by a competitor, saying instead that he used his own vaccine to inactivate the bacilli by oxygen. Source: http://ccnmtl.columbia.edu/projects/rcr/rcr_misconduct/foundation/index.html#1_B_1

How common is scientific fraud? • Columbia University website on responsible conduct of research reports misconduct cases represent .14% of all grant recipients (US National Science Foundation) (100 x lower than percentage from other data) • Cases of misconduct identified at institutions are resolved without notifying the NSF (even though they are required to do so)

Website Experiment-Resources.com • For every case of scientific misconduct reported widely, there may be as many as 10 cases that go unreported • Private research funding may encourage scientific fraud • Global warming debate one example cited where search for funds can encourage exaggeration of findings • “research tied to areas with mass appeal [can] driv[e] out pure science”

How common is scientific fraud? • Daniele Fanelli, “How Many Scientists Fabricate and Falsify Research? A Systematic Review and Meta-Analysis of Survey Data.” PloS One 4.5(2009): e5738. • 2% of scientists admitted that they had fabricated, falsified, or modified data or results at least once • 33.7% admitted to . . . “‘dropping data points based on a gut feeling,’ and ‘changing the design or results of a study in response to pressures from a funding source’.” (8)

Fraud witnessed by colleagues • 14% had witnessed others’ “fabrication, falsification and modification” of data • 72% had observed “questionable practices” • Rate of self-reports declined; rate of reports about others has not declined • Fanelli concludes “[T]here is little evidence that researchers trained in recognizing and dealing with scientific misconduct have a lower propensity to commit it [47,48,49]. Therefore, these trends might suggest that scientists are no less likely to commit misconduct or to report what they see their colleagues doing, but have become less likely to admit it for themselves” (10).

What policies exist to deal with misconduct and fraud? • 1995– “the National Academy of Sciences said that scientists are advised that ‘someone who has witnessed misconduct has an unmistaken obligation to act’ ” –Columbia University (http://ccnmtl.columbia.edu/projects/rcr/rcr_misconduct/foundation/index.html#1_C) • Whether people act depends upon whether their allegations will be treated seriously • Institutions should have policies in place to ensure confidentiality and no retaliation on whistleblowers

Study by Office of Research Integrity at Columbia University in US • 2/3 of all whistle-blowers reported experiencing at least one negative consequence as a result of acting • 90 % of whistleblowers who did not experience a negative outcome said they would do it again • 75 % of those who experienced a negative consequence said they would do it again

U of A Policy: Research & Scholarship Integrity Source: http://www.conman.ualberta.ca/stellent/groups/public/@research/documents/policy/pp_cmp_069274.hcsp

Antidotes to Scientific Plagiarism • American Society of Chemists (ACS) runs a computer program on all paper submissions • If a match is found with text published anywhere else, submission is rejected and author is barred from further submissions • This review prevents researchers from publishing similar papers in different journals

Questions for Discussion • What are some of the possible implications for society from fraudulent scientific and medical research? • For scientific and medical researchers? • For medical practitioners?

Writing as a Technology In Science and Medicine