Scientific Literacy Seminar investigates relevancy to social professions
by Irma S. Jarcho and John L. Roeder
Columbia University Provost Jonathan Cole began a new series of talks on "Education in Science Relating to the Social Professions" at Columbia University's Scientific Literacy Seminar on 7 October 1997. Speaking on "Science Literacy and the Two Cultures," Cole observed that the gulf between the "Two Cultures" first described by C. P. Snow is as great as when Snow first described them in 1959. "Why does the gap still exist today?" he asked. "Why are so many people still so scientifically illiterate?"
One reason, he suggested, is that people at an early age are labeled as to whether they are scientifically inclined. This is based primarily on the ability to solve problems, not on the ability to ask extraordinary, interesting questions.
This gap has serious cultural consequences, especially now that the half century post-world War II partnership between government and science is being downsized. It isn't that those involved in science policy are anti-science, Cole claimed. Rather, he argued, they just do not know much about science and how it operates. Some see science as hostile to human values, despite extraordinary advances in health. Leaders like President Vaclav Havel of the Czech Republic think science is depersonalized.
Although Columbia University requires a year and a half of science for graduation, Cole lamented that this offered little opportunity to take courses about the processes or history of science. This leaves nonscience students to learn about the process and history of science from their history texts -- and there, Cole observed, the pickings are very slim. Indeed, he acknowledged, some history texts are written as if science and technology didn't exist.
The resolution Cole saw to this dilemma was for science teachers to capture the imagination of students not going on to a scientific career. How does one teach nonscience students about the achievements of science and give them a more profound scientific understanding, he asked. And are scientists willing to take the challenge of teaching nonscience students?
The next to speak in the Scientific Literacy Seminar series on "Education in Science Relating to the Social Professions," on 20 November, was Emeritus Columbia University Law Professor Frank Grad. Speaking on "The Quest for Truth -- in the Courtroom and in the Laboratory," Grad observed that legal factfinding involves investigation of claims by plaintiffs within a limited time and with limited resources. Hypotheses can be tested, he noted, though in cases of public health (which he cited along with drugs and the environment as pertinent areas of science related to law) large groups are needed. Grad added that cause-effect, dose-response issues are of special interest to the law, and he emphasized that replicable results are as important to lawyers as they are to scientists.
Although most legal cases at present do not involve expert scientific testimony, Grad acknowledged that product liability cases, especially class actions, involve scientific and technical evidence to a great extent. Until the case of Daubert v. Merrell Dow Pharmaceuticals in 1993, the basis for admitting testimony from expert witnesses had been the "Frye" test of "general acceptance," established in the 1923 case of Frye v. United States. According to the "Frye" test, animal data which expert witnesses sought to admit in the Daubert case was rejected for lack of support by peer review epidemiological studies on humans. When the Daubert case was appealed to the U.S. Supreme Court, Justice Harry Blackmun rejected the "Frye" test, holding that a judge should be entrusted to be a "gatekeeper" for admitting scientific evidence in a trial on the basis of its relevance. The Supreme Court remanded the case back to the lower court for a loosening up of the rules for admitting scientific evidence, with the revised guidelines for admissibility becoming the significant aspect of this case.
According to Grad, the new test prescribed by the Supreme Court was "reliability" and "relevance." The previous Frye criterion of "acceptance" became one of only four criteria according to which evidence could be deemed admissible, the other three being testability, peer review, and tolerability of error rate.
Grad reported that the Supreme Court also expressed concern about the ability of highly-paid expert witnesses to mislead jurors. The motivational impact of the evidence is not allowed to overcome its scientific value -- e.g., a plaintiff is not allowed to introduce a severed limb. Chief Justice William Rehnquist expressed concern that the judge was being asked to be an amateur scientist. Grad hoped that judges would be bright enough to handle this.
The Daubert rules for admissibility of scientific evidence strictly apply only to federal courts, Grad noted, but he stated that some states have also admitted them. A witness qualified by knowledge, skill, or training may give opinion or even hearsay opinion (rule 702). However, Grad cautioned that this does not apply in administrative hearings, which lead to rule making within the context of prescribed law. Such rules may not be "arbitrary and capricious" and must take into account "all relevant factors" and be free of "clear errors of judgment." The courts are not allowed to substitute their own scientific expertise for that of the rule making agencies, he added.
David Rothman, Bernard Schaumberg Professor of Social Medicine at Columbia University's College of Physicians and Surgeons, continued on 11 December by addressing the role of scientific literacy (or, more specifically, medical history) in the medical profession in a talk which asked "Can Patients be Consumers? Can Physicians be Partners?" Originally (and still) a Professor of History, Rothman was asked because of his research interest in the history of caretaker institutions to assume the Schaumberg Chair, named for a psychiatrist who sought to incorporate issues of ethics and values into the medical school curriculum.
When he assumed the Schaumberg Chair, Rothman was medically illiterate. Going on rounds with physicians and their students like a general who had never picked up a gun, he quickly recognized three types of medical illiteracy:
1) technical (unawareness of meaning of technical terminology),
2) obscurantist (unawareness of terms patients can't understand, like "hematoma" instead of "bruise," or "febrile" instead of "having fever"), and
3) colloquial (unawareness that a "bad historian" is a patient from whom it is difficult to get a good case history). Yet repeated exposure to medical technology gradually made him medically literate, and he continued by iterating the several developments of the past decade which have motivated many groups of the public to become medically literate as well.Rothman acknowledged that literacy in the world of medicine is important in what he called "street battles," such as contraception and other issues brought forth by feminism (as illustrated in the first edition of Our Bodies, Ourselves (Simon & Schuster, New York, 1973)). Obstetrics and gynecology never recovered from this, Rothman stressed. It is now overwhelmingly a female speciality, except for those over 50. Challenging the need of women for two doctors, gynecologists are now regarding themselves as providing primary care.
Also in the 1970s came the movement to be truthful in diagnosis of fatal diseases -- and this required communication in standard English. Along with this, bioethical issues played a major part. Another "street battle" led to formulation of the "Patient's Bill of Rights." Relative to these "street battles" malpractice paled in significance.
Then in 1983 the onset of AIDS brought a new organized group -- the "AIDS community" -- mistrusting medicine. They advocated sharing drugs so that those receiving placebos in controlled studies would not be deprived of potentially efficacious medicine, thus fouling many of these controlled studies. The "AIDS community" caused the mobilization of victims of still other diseases -- e.g., Alzheimer's, breast cancer -- thereby motivating still other groups to become medically literate.
Even more motivating for people to become medically literate is the advent of HMOs and managed care. The public is learning about medicine from ER, and so are medical students, Rothman claimed. Possibly due to the demise of L.A. Law along with the ascent of ER, medical applications have soared while law applications have plummeted. Nothing has spawned mistrust of medicine like HMOs, he said. People are also acquiring medical literacy from the World Wide Web. Many lay people either subscribe to the New England Journal of Medicine or read it on the web. The health sections of bookstores have grown out of proportion -- with titles like "What To Do After the Doctor Comes" replacing "What To Do Until the Doctor Comes."
Not only is The New York Times providing a prŽcis of the New England Journal, Rothman noted; it is even starting to look like it in terms of pharmaceutical advertisements, as if patients should be requesting specific brands from their physicians. Under HMO capitation, physicians spend less time per patient while seeing more of them, thus leaving more to nurses and videos. Medical schools train doctors to gather information from patients, but not to transmit information to patients.
Rothman summed up his presentation of factors motivating medical literacy by observing that it is a felt street need being pursued by everyone everywhere. Medicine has developed so many "tricks" that now more than ever is a time for policy control of the field, he added. Not to become medically literate is to abandon power to those who have developed the "tricks" -- and he concluded that we might end up regulating what we shouldn't, and vice versa.
(Editor's Note: Further information about the broadening of the "Frye" test in the Daubert case is presented in Science, 261, 22 (2 Jul 93), listed as resource #12 in our Fall 1993 issue. More recently, the 22 December 1997 issue of Chemical & Engineering News reports on page 8 that in the case General Electric Co. v. Joiner the U.S. Supreme Court reversed an appelate court's reversal of a lower court judge's disallowance of expert testimony about exposure to PCBs on the grounds that "the experts' conclusions were not supported by the scientific papers they cited.")
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