Jewish World Review Sept. 5, 2003 / 8 Elul, 5763

Drs. Michael A. Glueck & Robert J. Cihak

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Unholy medicine | An old Yiddish (or is it Irish or Chinese?) joke tells of a man who comes home early one afternoon to discover his wife in bed and his next-door neighbor hiding in the closet. Enraged, he confronts the man: "What are you doing here?"

His neighbor shrugs and replies, "Everybody gotta be someplace."

We now know where the "prestigious" New England Journal of Medicine (NEJM) can be found, at least on one issue. And while we applaud its honesty, we must point out that in the issue of human cloning, honesty without objectivity is not the best policy - for medicine or humanity.

In the July 17 issue of the NEJM, editor Jeffrey M. Drazen, M.D., took issue with the House of Representatives' decision to ban research on and medical use of treatments "derived from embryonic stem cells." He then wrote:

"The editors of the Journal will do our part by seeking out highly meritorious manuscripts that describe research using embryonic stem cells."

Two weeks later, Wesley J. Smith, a fellow of Seattle's Discovery Institute, pointed out in National Review Online the downside of this honest advocacy. While everything the NEJM might publish on the subject could be entirely true, it would be far from the entire truth. What would happen, he wondered, "if the Journal received a manuscript reporting that an attempt to use embryonic stem-cell therapy in mice to treat, say, diabetes, had failed? Disclosing failures is as essential a part of the scientific process as touting successes. Or, what if a submission for publication indicated that embryonic stem cells' known propensity to cause tumors when injected into animals may be insoluble? What then?"

Smith's questions expose the dreadful problem of conflating objective science with political advocacy. They also demonstrate how "peer review" can be suborned to non-scientific agendas. But they also reveal two other problems rampant in the medical and scientific communities.

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The first is Political Correctness. We've been writing for years that peer review as practiced by the editors of the NEJM often includes an ideological review to be certain that the manuscript agrees with its worldview or agenda. Public news media of all persuasions have similar policies. But they don't do science.

Politicized peer review is as wrong here and now as it was in Russia when Stalinist lackeys trashed Soviet genetics in favor of Lysenko's Good-Marxist notion that acquired traits can be inherited. More wrong. Lysenkoism failed as junk science. Stem-cell research and cloning are for real.

Nor is medical PC any new thing. For decades, elite medical journals have published articles perceived as favorable to one side in public issues - for example, in the areas of gun control, sex education and the psychological complications of abortion. Fortunately for real science, the truth about these human issues is slowly coming out.

Further, such huffing squanders other opportunities. For years, one of these writers pleaded with the NEJM to take a strong stand on the issues that really affected medicine, such as third-party control of physicians and interference by managed-care managers, trial lawyers and political powers - not to mention the hyper-regulation and paperwork that take precious time away from doctor-patient contact.

On those rare occasions when the Journal said something, it was always too little, too late and too Politically Correct. Heaven forbid it would hurt the feelings of the politicians and the legal scavengers, not to mention anybody with research money to distribute.

Second, there's the matter of snobbery. Most practicing physicians in this country are quite aware that unless a manuscript is from a "prestigious" Eastern or elite medical school and is consistent with the editors' worldview, there is little chance of being published. The NEJM has abused this editorial privilege filtering out medical science for years, just as the New York Times and CNN have filtered out the news. Rather than "All the News That's Fit to Print" these media giants disseminate "All the News That Fits."

But again, scientific and medical publications aren't mass media, and when PC snobbery joins with the hauteur of the scientist, it's doubly troublesome.

Why would editor Drazen suddenly take this one-sided stand on cloning, which entails far more than science? On Aug. 10, 2001, in an "Insight" commentary titled "Blood, Guts & Glory: The Stem of the Stem Cell Controversy we wrote, "Ultimately, it seems that the debate is not so much between science versus religion, but between conflicting religious, or if you prefer, "belief" systems that will never be reconciled."

But now Dr. Drazen portrays himself as a scientist and implies that his political judgment is more important than the judgment of either the Congress or his citizen peers. But his editorial, as Wesley Smith points out, owes less to science than to hope.

Drazen writes: "Although the science of creating genetically compatible tissues with the use of somatic-cell nuclear transfer is in its infancy, as a community of scholars, we know that this approach to treatment is now possible. Since the precedent has been set, there is no question but that somatic-cell nuclear transfer will be used to develop treatments for conditions that are currently uncurable."

This double supposition is not science. It's belief in things unseen scientifically - and grant-grabbing political rhetoric.

Fortunately, there is a simple way out. Accurate news and science reporting belong on different pages than editorializing. The editors of the NEJM can simply start behaving like the editors of local newspapers and other medical journals who publish reporting on the news pages and varied, informed opinions on the opinion pages. Also, the NEJM could establish a new policy whereby the editors who review manuscripts are independent from those who write the editorials.

Yes, everybody gotta be somewhere. But like the neighbor in the bedroom closet, how you get there also matters greatly.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a past president of the Association of American Physicians and Surgeons and a Discovery Institute honorary fellow and board member. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


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