Factors affecting the independence and reliability of Science and how these are perceived

Science studies natural phenomena or uses laws, theories, models and mechanisms to explain them, which are revised when new evidence emerges. However, Science cannot give answer to all questions that may arise. The benefits of science are well known and there is no reason to expand on them. It is of interest though to examine the structure and factors that influence the scientific world and may hold it back from offering greater benefits to mankind. The current study is concerned with the question whether or not Science is independent and reliable. Social and political reasons can direct substantive research in specific areas, but they can also encourage the promotion of unfounded theories. External factors such as prejudice against new ideas and understanding of natural happenings can negatively affect the objectivity of Science. Such factors examined in this paper and influence Science are: Research funding, policy makers and industry; Journal editors; Dogma; Theories declared as Conspiracies; Mutual interests in Academia; Knowledge control, cover ups and war superiority. The above factors can be used negatively to restrain serious scientists from expressing educated opinions and publishing them in scientific journals. In this way healthy discussions between 'opposing parties' are restricted, with Science being the victim as no sound conclusions and consensus on important subjects are reached. To check how the above positions are perceived by the scientific community, a questionnaire was circulated among scientists in 11 countries. Analyzing the 106 responds that were anonymously received, indicated that the respondents were largely in line with the expressed positions of the present paper. It is proposed that the real answer to minimize the effect of the factors that influence Science negatively, is educating people's critical abilities and considering nothing for granted-especially under the influence of powerful Media-unless its validity is independently checked and verified.

Zone 1 and 2 flexor tendon repair via a longitudinal incision crossing the volar distal interphalangeal joint: functional and cosmetic outcomes

INTRODUCTION

The primary aim of this study was to present patient-reported functional outcomes after zone 1 and 2 flexor tendon repair using a novel longitudinal volar approach crossing the distal interphalangeal joint (DIPJ) perpendicularly. The secondary aims were to investigate the cosmetic outcomes, satisfaction and complication rates associated with this technique.

METHODS

Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases.

RESULTS

The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair.

CONCLUSIONS

Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.

Challenging management dogma where evidence is non-existent, weak or outdated

Medical practice is dogged by dogma. A conclusive evidence base is lacking for many aspects of patient management. Clinicians, therefore, rely upon engrained treatment strategies as the dogma seems to work, or at least is assumed to do so. Evidence is often distorted, overlooked or misapplied in the re-telling. However, it is incorporated as fact in textbooks, policies, guidelines and protocols with resource and medicolegal implications. We provide here four examples of medical dogma that underline the above points: loop diuretic treatment for acute heart failure; the effectiveness of heparin thromboprophylaxis; the rate of sodium correction for hyponatraemia; and the mantra of "each hour counts" for treating meningitis. It is notable that the underpinning evidence is largely unsupportive of these doctrines. We do not necessarily advocate change, but rather encourage critical reflection on current practices and the need for prospective studies.

Anastomotic Leak: Toward an Understanding of Its Root Causes

BACKGROUND

When an anastomotic leak is discussed at a typical surgical morbidity and mortality conference, it is often presented as a due to an error in surgical technique involving ischemia, tension, or device failure. Here we assert that without direct visual analysis of the leak site and its tissue histology, an ex post facto claim that an anastomotic leak is due to an error in surgical technique remains speculative.

METHODS

The arguments and rationale used to conclude that an anastomotic leak is due to an error in surgical technique are critically reviewed and assessed for their validity.

RESULTS

No case series or literature exists in which a root cause analysis has been carried out with visual and tissue level evidence to determine the root cause(s) of an anastomotic leak.

CONCLUSIONS

At the individual case level, declaring that an anastomotic leak is due to an error in surgical technique without clear and compelling evidence either visually and/or at the tissue level to substantiate such a claim remains speculative.

Cystic fibrosis: myths. mistakes, and dogma

As a student I recall being told that half of what we would learn in medical school would be proven to be wrong. The challenges were to identify the incorrect half and, often more challenging, be willing to give up our entrenched ideas. Myths have been defined as traditional concepts or practice with no basis in fact. A misunderstanding is a mistaken approach or incomplete knowledge that can be resolved with better evidence, while firmly established misunderstandings can become dogma; a point of view put forth as authoritative without basis in fact. In this paper, I explore a number of myths, mistakes, and dogma related to cystic fibrosis disease and care. Many of these are myths that have long been vanquished and even forgotten, while others are controversial. In the future, many things taken as either fact or "clinical experience" today will be proven wrong. Let us examine these myths with an open mind and willingness to change our beliefs when justified.