Christian and Medical Research
By Sam Leinster and Helen Barratt
Although only a minority of doctors will be actively involved in research, all doctors will feel its impact. The implications of research findings are also often the subject of popular discussion. It is therefore important that we all understand the assumptions, methods and challenges of research. For Christians, there is the added challenge of developing a biblical understanding of the utility and limitations of research.
Research is central to the safe and effective practice of medicine. Developments in molecular biology over the past 50 years have affected our understanding of normal human biology and pathophysiology, and new drug development is now often targeted against specific molecular receptors and mechanisms. This in turn requires new, more sophisticated approaches to running clinical trials to target the subset of a disease population who display a specific molecular market. New approaches to population-based research have also been developed, as simple descriptive epidemiology has given way to complex study designs needing complicated analysis, made possible by the rise of computer power.
Until the late 20th century, medical research was either laboratory-based or focused on a statistical approach to knowledge. Both approaches are rooted in a positivist paradigm (see Glossary) which assumes there is an absolute reality to be discovered – or in other words, there is a world out there for us to measure objectively and investigate. The task of the scientist is to uncover that reality. This paradigm has been responsible for the rapid technological advances that have transformed healthcare over the last 75 years.
However, there has also been an increasing recognition that other influences, such as psychological and social factors, play an important part in health and illness. While there is a substantial body of experimental and quantitative research (Glossary) in psychology, data in this field is usually collected using qualitative interviewing techniques (Glossary). This is carried out within a different postmodernist paradigm (Glossary) in which knowledge is socially constructed (ie created by us). Meaning depends on the individual interacting with the data as they interpret it, rather than being a description that can be generalised of an external and independent reality.
This File takes the form of a discussion between a junior researcher, Helen, and Sam who has been actively involved in research in a variety of fields for over 30 years.
Is it right to do research?
While the General Medical Council’s guidance Good Medical Practice defines the first duty of the doctor as the care of the patient, it also makes it clear that providing that care requires the practitioner to ‘provide effective treatments based on the best available evidence’.1
Valid evidence can only be obtained through properly designed research studies, so at a purely pragmatic level, being involved in research is an intrinsic part of delivering patient care. Not every doctor needs to undertake research personally, but everyone needs to understand not only how it is done but also how apply the validated results.2
I believe there is also a biblical imperative. Scientific study is based on the presupposition that the universe is rational. If it is not, then any attempt ti study it is futile. Because the universe is rational, it is predictable within certain statistical parameters and therefore open to experimentation. For the Christian, the rationally of the universe is the result of its creation by God. Because the universe is created by God, we have a two-fold responsibility towards it: we are required to preserve it and we are encouraged to explore it. The latter constitutes the Christian’s mandate for research.
Tensions between worldviews?
It would probably help to define the scientific worldview, because the term is often used rather loosely. Credit for introducing the scientific method is usually given to Francis Bacon (1561 – 1626). In his view, the essence of science was making structured observation and from these developing general laws and theories by a process of induction. Deductions from these laws and theories lead to predictions and hypotheses which can be tested in properly designed experiments. If these prediction are borne out in practice, then the theories can be accepted as true.
The problem with this straightforward scheme is that it is based on the assumption that observation is objective. However, it is now well established that observation is altered by perception and is, in fact, theory-driven. That is to say, we see what we expect to see. This is the basis for many optical illusions.
Bacon’s scheme was refined by Karl Popper (1902 – 1994). Popper’s insight was that hypotheses can never be proved ultimately. The aim of science is to attempt to disprove the current hypothesis which is held tentatively until new data leads to a new hypothesis (Figure). A hypothesis is valid not because we can devise a test that will prove it to be true, but because we can devise a test which could prove it false. This Popperian view has predominated in thinking about science for the last 50 years.
Whichever philosophy of science is espoused, at the heart of the scientific view is the assumption that the universe is governed by stable, rational laws which can be discovered by appropriate methods of investigation. This is entirely in keeping with the biblical viewpoint.
Where do qualitative methods fit in?
I think it is important to distinguish between the qualitative methodologies themselves and the philosophy of some of their proponents. I do not see there is a necessary connection between the two and I am quite happy to use qualitative methods when these are appropriate for the research question that I am answering. After all, I do not reject the methodology of the biological sciences because some of the proponents of those methods are militant atheist who would deny God any role in the universe.
There are times when I want to know how a particular group of people in particular circumstances think or feel. For example, how does a selected group of 4th year medical students react to a given professional situation? In my view, the only acceptable methodologies for this type of question are qualitative ones. While I can’t claim to have uncovered some absolute reality, I can claim to have uncovered the reality of what is happening in that given situation. My findings may not be generalisable to all people in all circumstances, but I can reasonably assume that other medical students with similar experiences will have the same attitudes.
It is part of the qualitative process that I should explicitly recognise my own biases in interpreting the data, but this is different from saying that my findings are entirely subjective. I am implicitly assuming that the findings from my study will be congruent with the findings from another study conducted on the same population.
I am not sure that those who follow the post-positivist paradigm (Glossary) are entirely consistent in their behaviour. Why carry out research unless there is something measurable? Why do it if the results are entirely subjective? Research proceeds on the assumption there is something that must be independent of, though clearly influenced by, the observer. (The effect of observation applies to sub-atomic particles as well as to human beings.) There would be no point in studying patients’ compliancce with medication,
for example, unless we believed there was some thing which influenced it that was amenable to manipulation and modification.
For the Christian, God is the only absolute reality, but even our knowledge of him is incomplete.3 Therefore, in an intellectual sense we cannot claim to have grasped absolute reality. Our certainty is based on the relationship which is possible with God through his revelation to us in the person and work of Christ, not on our ability to explain him. For the scientist, whether the methods used are quantitative and qualitative, theories represent the best description of things as they are, given our present level of knowledge.
Read more: Christian and Medical Research (part 2)
- GMC Good Medical Practice, London 2006 www.gmcuk.guidance/good_medical_practice.asp
- GMC Guidance on Research, London 2010 www.gmcuk.org/guidance/ethical_guidance/5992.asp
- 1 Corinthians 13:12
Christian Medical Fellowship (CMF) Files No. 42, 2010