The study of the growth of knowledge started in about 500BC in the Golden Age of Athens. The picture is a detail from Raphael's fresco in the Vatican. It shows Plato pointing to heaven as the source of wisdom whilst Aristotle makes the point that wisdom has to be acquired/1
Aristotle supported by Euclid, developed methodology that was the birth of scientific enquiry. It included syllogisms and "proofs" this may have had worked for algebra but failed to add to the sum of knowledge in cosmology or biology./2
In the dark ages the power of the Church decreed that all knowledge was given in the holy scriptures. Galileo like other scientists at the time. was at risk of death at the hands of the inquisition, his conjecture that the universe was heliocentric was considered heresy. /3
The "Age of enlightenment" saw the rebirth of science.
This painting in the National Gallery illustrates an experiment with an air pump by Joseph Wright of Derby. Note the "mad scientist" at the apex of the pyramid and the cockatoo replacing the dove of the holy spirit./4
The flaw in science at this time was that all the experiments were designed to prove an hypothesis (induction) as argued by the great Scottish philosopher (David Hume 1711-1776) /5
I would now jump forward to the mid 20th C and the teachings of Karl Popper (Prof of the History & Philosophy at LSE). His classic the "Logic of scientific discovery", turned science on its head by claiming that discovery was dependent on falsification not corroboration. /6
I was captivated by this idea and took the practical step of establishing a clinical trials centre at Kings College. Here is a slide I used when justifying RCTs in the 1980s./7
To my surprise and delight I got a letter from Sir Karl Popper asking me to visit to discuss how his philosophy could be the justification for RCTs. Below is an extract from that letter where he mentions my paper "Limitation on non-science in the epistemology of surgery"/8
And here is the picture of our meeting. He was the smallest giant I have ever met!/9
He died two years after this meeting and in 2007, I had the honour of delivering the Karl Popper memorial lecture at LSE. His autobiography was entitled "Never ending Quest". The paths of scientific philosophy did not end with Popper but I will allow him the last word./10
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My letter in the Times has generated a lot of interest so I thought it might help if I described the time line for reaching this frame of mind. I attach a copy of the letter and then run through a series of tweets to tell the story.
I was one of the architects of the NHS breast screening programme (NHSBSP) and opened the first unit in London whilst Prof of Surgery at Kings College Hospital in 1988. At that time it seemed self evident that catching breast cancer early would save lives.
Within a short period of time I noticed an anomaly. Duct carcinoma in situ (DCIS) an assumed precursor of invasive cancer, was detected in 20% of our “positive” mammograms when in clinical practice it was only seen in 1% of cases. We thought that was a good start.
Screening revisited.
For every complex problem there is an answer that is clear, simple and wrong. (H.L. Mencken, American Journalist 1880-1956)
Screening fails because it is based on a flawed assumption that the kinetics of growth are linear or log linear as illustrated here.
The logical inconsistencies in this model are multiple for example: 1. Recurrences can occur between 1-25 years with a peak hazard ratio at 2 years after surgery and a second wider peak 7-9 years. 2. The amplitude of the first peak reflects prognostic factors.
I have been provoked to start a webinar about progress in breast cancer care following the tragic early death of Sarah Harding as covered in the Times today. That together with the flood of tweets implying that delay in diagnosis was to blame./1 thetimes.co.uk/article/sarah-…
My mother died in her early 60s in uncontrolled pain from skeletal metastases. She had neglected herself and presented with advanced disease.I was a young surgeon at the time and decided to devote my career to the management of this disease. /2
27 years ago my beloved young sister noticed a small lump in her breast and I made sure that she was treated promptly with breast conserving surgery and 5 years adjuvant tamoxifen. I claim to be one of the pioneers responsible for these interventions./3 en.wikipedia.org/wiki/Michael_B…
"A plea also for left and right press; stop attacking the character and motivation of the people trying to help get UK out of this." @ewanbirney
Thank you Ewan, I'm glad someone at last has had the courage to make this comment. You have provoked a chain reaction response/1
I start with a disclaimer that I have no conflict of interest other than being pro Europe and having voted for Luciana Berger against the Tory sitting candidate.
I find it disgusting when armchair critics of HMG's response to this plague, question their motivation/2
I believe that all the ministers and scientists we see at press conferences are equally well motivated as any of the virtue signalling critics on Twitter who seek power without responsibility. The burden of responsibility of HMG must be back breaking./3
I've been inspired to initiate a debate about the comparisons in outcomes between different countries in their efforts to deal with the corona virus pandemic, by this graph posted by James Barr./1
First my credentials. I founded the first cancer clinical trial's centre in the UK 1981 and directed it in various iterations for 30 years. I have no political affiliation and am driven by science. I'm an experimental clinical scientist not an epidemiologist. 2/
Epidemiology is observational science and is good at detecting associations between environmental and behavioural factors and links with disease. Association does not prove causation but is valuable in generating hypotheses to be tested in clinical trials (RCTs).3/