Posted by Pattie on 3/15/2003 02:29:00 PM


There has been an interesting discussion on a list serve I follow called "Show Me the Data" which looks at data about obesity research with a certain amount of skepticism. Many of the people on the list (if not all) belong to a growing number of researchers and practitioners who believe in Health at Every Size as a paradigm for encouraging healthy eating and exercise without relying upon restrictive dieting and punitive exercise with weight loss as a goal.

After writing the following e-mail, I decided it might be good to post it on my blog...

I have had limited access to my e-mail. I could read your discussion but couldn't respond at the remote location I was in for the past few days. It was both exhilirating and incredibly frustrating to read this list during that time. This has been a great discussion on several planes. The sociology of scientific knowledge remains my favourite topic for reading, thought, and writing. So this discussion raises a topic near and dear to my heart. I have been saving my thoughts on this for several days, so below is a rather long analysis/rant. Proceed at your own peril :D.

I read with the most interest the part about what science is and is not, and how science benefits us. I have to disagree with Paul E. when he said "Obesity science is the only arena I work in where data and facts that don't fit an economically and culturally mandated paradigm are swept under the rug." First, I think the history of medicine is filled with similar stories, usually involving groups who suffer stigma in society--minorities, poor people, elderly, women and so forth. Obesity is the latest in a long list of pathologies that are questionable, including eugenics, women's hysteria, phrenology, medicalization of race, and a long list of questionable "research" practices including the Tuskegee experiments on black men, the drug trials for DES, the birth control pill, and the Dalkon shield and of late, some questionable practices around pharmaceuticals creating syndromes to treat in order to extend their patents. Second, I think all medical research occurs within the context of the economic, the social and the cultural. Obesity and the other examples I've given may be extremes of this influence, but no research is done without funding and no research is done without human beings -- funding and human involvement means that cultural influences exist and therefore the data and presentation of data are going to be judged by cultural paradigms and those things that don't fit will be probably ignored or diminished.

However, I agree with Paul E., and others, that scientific research is valuable. The recognition that science is not objective and is culturally informed does not diminish its value. In fact, I believe such a recognition can increase its value because we will be more confident in our knowledge as we scrutinize our results.

Sandra Harding has written extensively about this. She points out in Is Science Multi-Cultural? Postcolonialisms, Feminisms, and Epistempologies there are four basic claims upon which science, as we think of it, is built:

1. There is just one world.
2. There is one, and only one, possible account of the world.
3. There is just one science that can piece together the one account of the one world.
4. There is a class of people who, due to their education and experience, can practice this science in a way that will lead to the one possible account of the one world.

Recognizing these assumptions and questioning them from time to time only leads to better knowledge. If we treat our assumptions as sacrosanct then we are simply practicing a religious exercise and we begin to treat scientists like priests who represent a special status that can't be examined. This is very dangerous and it is very prevelant in medical science.

"The free, unhampered exchange of ideas and scientific conclusions is necessary for the sound development of science, as it is in all spheres of cultural life. ... "==Albert Einstein, 7 Oct 1952 (from Ideas and Opinions, p166--Three Rivers Press, 1954[1982])

Questioning whether science can be objective should not be threatening to science or scientists. It is well within the spirit of the scientific method to remain skeptical. Questioning whether science can be objective, or recognizing that there is more than one way to interpret physical phenomenon, can expand knowledge and doesn't necessarily negate the existence of an objective world. It merely points out that we live in the fishbowl and therefore cannot escape that perspective.

What I object to is the lack of scrutiny that scientific and medical research and practice receive. The class of "scientists" are not the only ones who should be allowed to scritinize. Questions and critiques should be important no matter from where the questions come.

I read with interest the use of science and scientific methodology as rhetorical ploys in the e-mail exchange between Tish and the San Francisco pediatrician. Tish's personal childhood experience was dismissed as irrelevant or inferior information: "As a person working in public health and policy, I cannot base my opinions on a sample of one." On the surface this seems like sound reasoning, however this statement carries with it a lot of theoretical baggage, including the fourth assumption from Harding that only a certain class of people can speak with authority about scientific matters. This dismissal is not scientific. It is highly political. Tish did well to point out that this pediatrician's agenda affected her reasoning. The doctor's agenda informed her statements about the term "overweight" being merely "medical" and therefore uncontestable. By realizing the doctor's agenda, one can indeed question the term "overweight" on levels other than its medical usage or measurability. This is the kind of use of science for social control and social status that bugs me because it is so often left unmarked. Hell, half the time we don't even mark the scientist. "Science says ...." "Science proves..." etc.

The "scientific fact" is equally fraught with unmarked politics. In my understanding of how scientific knowledge is to be created and produced, I believe that there can be no such thing as a "scientific fact." I take a fact to be something observable, documentable and measurable. Facts either support or detract from particular scientific theories. Tish's exchange with the pediatrician brings this out as well. The doctor essentially defended the use of weight as a parameter for the taskforce simply because it was easy to measure. Any "facts" she gathers is based upon this decision. She rejects hard to operationalize concepts such as "health" or "fitness" for the more concrete "weight" measurement. This would be okay, scientifically (not politically) if she were to admit to the limitations it places upon the results and the lack of validity as a measurement of health. Instead, however, the doctor asserts that the validity of the measurement cannot be questioned because she believes it is a "fact" that "overweight" has some health consequence. This is fallacious in at least two ways: First, she is confusing her measurement of something with the thing itself. This is a fallacy of circular reasoning. She is drawing a conclusion (overweight is a medical measurement) to support the evidence that results in those conclusions (we measure weight because it is easy to watch and then we conclude that weight matters.) Second, she is appealing to medical authority as if it were a unified, unbiased and otherwise singular thing. This is a fallacy of authority. To assert that doctors do it and therefore it cannot be dismissed is simply asserting status and raises no real scientific reason for the practice. Facts drawn from this fallacious approach can appear scientifically acquired and be asserted as "scientific facts" but in the end only a skeptical view of them will bring one closer to the truth (as I'm sure this list understands, since it is called "show me the data").

Some observable, documentable and measurable phenomenon called facts add up to pretty strong evidence (gravity seems pretty consistent in the universe so far), but facts are not in and of themselves science and scientific knowledge does not produce conclusions or facts. The door should always be left open for examination because it is within that moment of curiosity and observation that more scientific knowledge can be obtained. The use of the term "scientific fact" is a rhetorical ploy to use the legitimacy of science to prove a case. I always make it a point to scrutinize with skepticism anything touted as "scientific fact." Someone is usually selling something when they use it. Caveat emptor.

Science is valuable only to the extent that it is useful. Experimentation is extremely pragmatic: results must be reliable for sure, but they must also be valid. We need to know why we are measuring something, if our measurements actually measure the phenomenon we say they are and if these measurements can accurately capture the phenomenon being measured. I value greatly what medical research has provided. I owe my life to PAP smears because I would have had no way to know of the precancerous cells that had been growing in my body without it. I get a flu shot every year. I take medications developed by researchers on a regular basis. I don't object to the value of these kinds of endeavours and I am glad that such endeavours are always improving. I simply believe that this knowledge should be shared and scrutinized. I don't think of the scrutiny as hurting science as a useful tool. Instead, I think it makes it more useful. Knowing the influences upon a given study, the background of those conducting the study, the funding of the study, etc. allows people to decide for themselves regarding the validity of findings.

Obesity research is indeed one of the areas where I see a great lack of utility and a lot of unmarked political baggage hiding under the guise of "scientific fact" (I'm going to use "medical fact" here as a synomyn for "scientific fact" though I'm aware that this could be a whole other topic.) Even the word "obesity" deserves scrutiny because it is a medical term that has never been clearly defined and has yet to even prove itself a pathology. "Fat" is a descriptive term. "Obesity" is a medical term implying that fatness is a disease. While there might be some credible research that links the physical characteristic of fatness with certain diseases and physical ailments, I have found no credible argument that demonstrates obesity as a disease in and of itself. Yet it is constructed as one constantly and any further obesity research, no matter how scientifically sound that research may be, is tainted by this lack of credibility. No one studies "fat people." They study "obesity." There is a world of differences, as Tish's discussion with the pediatrician points out. A fat kid is a real person with considerable complexities, including, but not limited to, the stigma he or she suffers from being marked as inferior because of his or her fatness. An "overweight" kid is a medical entity that will be measured with some meaning attached to changes in that measurement. The fact that the "overweight" label might hurt the "fat kid" is irrelevant to the doctor because she continues to unmark the politics of "overweight." The only solution to the stigma that the doctor offers is to be removed from the stigmatized class (lose weight) and the implication is that all those left in the class are indeed a product of their own making. Tish, in the doctor's mind, is not allowed to question this "medical fact" because she does not belong to the medical class, and, indeed, belongs to the stigmatized class. The belief that Tish (or someone like her) has no legitimate critique within the doctor's rhetoric is sociological and political, not medical or scientific.

Recognizing the economic, social and cultural contexts of research allows scientific and medical knowledge to be scrutinized and improved and therefore, it makes it more powerful and useful. Scientific researchers should not fear this scrutiny if they truly want to create the best science they can. Only open discussions with all interested parties can create this kind of powerful knowledge and that is why I value such discussions on this list. It has been enlightening in many ways.

I'll leave with one more quote from Albert (with forgiveness of his sexist language):

"Man tries to make for himself in the fashion that suits him best a simplified and intelligible picture of the world; he then tries to some extent to substitute this cosmos of his for the world of experience, and thus to overcome it. This is what the painter, the poet, the speculative philosopher, and the natural scientist do, each in his own fashion. Each makes this cosmos and its construction the pivot of his emotional life, in order to find in this way the peace and security which he cannot find in the narrow whirlpool of personal experience.

"What place does the theoretical physicist's picture of the world occupy among all these possible pictures? It demands the highest possible standards of rigorous precision in the description of relations, such as only the use of mathematical language can give. In regard to his subject matter, the physicist has to limit himself very serverely: he must content himself with describing the most simple events which can be brought within the domain of our experience; all events of a more complex order are beyond the power of the human intellect to reconstruct with the subtle accuracy and logical perfection which the theoretical physicist demands. Supreme purity, clarity, and certainty at the cost of completeness.
"== Albert Einstein, 1918, given as an address at the celebration of Max Planck's 60th birthday (from Ideas and Opinions, p166--Three Rivers Press, 1954[1982])