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Science Heroes and Disillusion

Cartoon of people discussing EBM heroes

“Never have heroes” – I’ve heard some version of that a lot in the last couple of months, from people disillusioned by John Ioannidis’ contributions to the research and debate around Covid-19. Meanwhile, others are still calling him an EBM or science hero.

It sounds like it should be a contradiction in terms, doesn’t it? – “EBM hero”. The essence of evidence-based medicine (EBM), after all, is meant to be the rejection of eminence-based medicine – believing something just because someone up high says it is so, with a bunch of cherry-picked citations.

But I think there can be, and indeed are, EBM and science heroes. I found a 2011 conceptual analysis of heroism and altruism by Zeno Franco and colleagues helpful for thinking this through. Which is seriously ironic, since one of the authors is Philip Zimbardo – an emeritus Stanford professor of notoriety because of that prison experiment!

Reading the article, though, crystallized how I, personally, think of heroism: it’s prosocial behavior, that’s altruistic, struggling against odds, and despite serious risks to the individual. It’s not hard to think of scientists, and healthcare providers struggling to ensure care is evidence-based, who fit that bill and are totally worthy of the label, hero.

While I was in the late stages of writing this post, Stuart Ritchie posted on the same theme, arguing “There should never be heroes in science”. He drew parallels from a couple of examples of scientists who achieved a lot of fandom and then fell, heavily, from grace in different ways: Hans Eysenck and Ioannidis. A common thread he pointed to, first in Eysenck, was that he “loved argument, loved controversy — and most importantly, refused in almost any case to back down under criticism”. Lately, he wrote, Ioannidis has sounded Eysenckian.

I won’t recap the recent Ioannidis episode – you can catch up on it in Ritchie’s excellent recap if you haven’t been following it closely. Ioannidis, he concludes, “gives the impression of someone who has taken a position and is now simply defending it against all comers”. I agree with that.

What’s interesting to me, though, is that not only isn’t this new, but people have been cheering Ioannidis on for doing just this for a long time. People used words for this kind of thing, like “heretic” and “iconoclast”, admiringly. I think those are the words we should be unpacking, more than the word “hero”.

Back in 2002, I wrote about how I had come to see “iconoclasm” as anathema to science and collaboration. It was after watching a bruising battle with another person many call(ed) a hero, but have recently grappled with disillusion about, Peter Gøtzsche. Iconoclasm, I wrote, has had a powerful side, but destruction and violence are also part of that word’s heritage: “Being brave and fighting for beliefs is easy to applaud. Yet, there is nothing valuable necessarily for humanity in doing it – not in itself. This behaviour does not necessarily have integrity, either. But there is always harm in fighting”.

The word “heretic” isn’t straightforward either in the science context. There’s a “contrarian” element to it, but a heretic is a proponent of a set of beliefs. And that’s a problem, whether it’s ideologically based or whether it’s a case that’s mounted in the way Ritchie describes for Ioannidis with Covid-19.

Jeanne Lenzer and Shannon Brownlee wrote a defense of Ioannidis, saying that he “will almost certainly emerge from this imbroglio with his reputation as a rigorous researcher restored”. I doubt that. David Freedman wrote that while Ioannidis’ legacy had recently “seemed unassailable”, speaking to a class of medical students this year he wondered, “To them Ioannidis may always be the fringe scientist who pumped up a bad study that supported a crazy right-wing conspiracy theory in the middle of a massive health crisis”.

I think the reality will include both those poles, but something else, too. Ioannidis’ work has always been of variable quality, but his status and reputation meant that would often be overlooked, or his rebuttals of criticisms too easily accepted. I don’t think that’s going to come back on that scale, and that’s a good thing.

Back in the before times, when we used to have lots of conferences, I would often either be in the audience when Ioannidis was speaking, or, from time to time, on the podium speaking alongside him. At first, I’d just be beguiled and energized by the rousing and erudite performances. But then a crack would appear – a statement I knew to be strongly contradicted by the evidence – and then another, and another. And they’d all be based on self-citations, building the case he was arguing.

Sometimes it would indeed be a very strong case – he does a lot of excellent work. But sometimes it was shot full of holes, yet with so many citations swirling past it seemed very evidence-based. It would be hard to refute without considerable effort: a scientific version of a gish gallop. I wrote about an example of this last year. When the Covid-19 writing began, for me, it was a case of “here we go again”, the early stages of motivated reasoning, with the studies on the way to backfill it. Once you’ve seen through it, an illusion stays broken; the former magic won’t work so easily the next time.

To me, the moral of these stories isn’t to not have heroes. It’s to learn a few things: to pick your heroes more carefully; to be wary of the champions of causes as well as anyone who is “against” something on the regular; to watch carefully how people respond to their critics; and to be on guard against the effects of charisma. And if you have a hero, don’t give their science a free pass.

~~~~

Disclosures: I’ve both collaborated with, butted heads with, and written critically about, both John Ioannidis’ work (starting here and here on Covid-19, and here in 2013 and here in 2019) and Peter Gøtzsche (see here).

The cartoon is my own (CC BY-NC-ND license). (More cartoons at Statistically Funny and on Tumblr.)

Discussion
  1. Great piece, thanks. It seems bizarre to me that anyone ever had him as any kind of hero. I mean he presents himself as oh so modest, but he wrote that cringeworthy letter to defend Gøtzsche where he said they should trust him because he’s one of the most cited academics in medicine. Truly embarrassing.

    As you point out he’s also consistently come out with some really poor, hyperbolic work. Like that one that claimed to have shown that most systematic reviews were a waste of time. How could his analysis ever have credibly shown that? (obviously it didn’t but who wants rigor and evidence to get in the way of a good story).

    I saw a talk of his once. It was truly dispiriting. He just reeled off study after study of his in quick succession (barely mentioned any other researchers). Each study supposedly illustrated a powerful point, but you just had to take his word for it – there was no sense of reflection, doubt, self-critique or genuine modesty.

  2. 1) I think someone may be considered a hero for what they have done and what they have achieved. It is in their (past) deeds, not in their being, not in their character, not in themselves.

    2) Behavior often has a range it is useful in. That depends on circumstances, often the initial situation, the forces that needed to be faced. When the situation has changed, the forces have been conquered, the behavior may lose its usefulness. After the war, the combination of characteristics that made the resistance fighter so decisive, often can’t find a role in their society once in peace time. Not rarely they go and find another war.

    3) I often find soccer a good model to look at things. In a soccer team there’s the goalkeeper. His contribution is to prevent the other team from scoring. Sometimes the goalkeeper becomes a hero by stopping a penalty, but generally defenders and the goalkeeper only get recognition from experts. The general audience is mainly focused on the strikers that make the goals. But in the end the strikers should make more goals than the goalkeeper and defenders can prevent. So the team needs both of them, the less glamorous defense and the show-stealing strikers. With a team of only strikers you will lose all your games. Still we focus on the strikers, most young teens aspire to become one, because strikers are the heroes. Soccer is not all about strikers.

    4) So heroism are not in them we consider heroes, but in us, considering them to be one. ‘Hero’ is at its most a brand, giving some indication of what we may expect, like quality, consistency, provocation, reassurance etc. But who is responsible for these expectations? And like all brands, their reliability may fade. Is it rational to expect they never will?

    5) Personally I hardly have any heroes. One looks different at the world that way.

  3. Thanks for what I sense is a reasonably balanced post.

    > to watch carefully how people respond to their critics
    I think this is key and possibly something that could be an early warning sign. It was responses to letters to the editor and blog posts/emails that really raised my concerns in particular about Ioannidis …

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