Editor’s note: With Dr. Gorski unable to contribute today’s post, we present instead this guest post by Benjamin Mazer, MD. Welcome!

A crisis of faith

The uncomfortable truth of science is that it survives largely on good faith. You’ll hear plenty of talk about transparency, logic, and evidence, and these are the ideals of the scientific method. However, the reality is our scientific institutions have historically encouraged a trust-based approach, essentially taking the methods and analysis scientists present at their word.

In recent years, many scientists have become less comfortable with trust alone, and have taken aim at corroborating scientific work. Pre-registration of clinical trial methods and mandatory reporting of results are becoming more common. Organizations are also asking to see raw scientific data, no longer satisfied at taking analyses for granted.

Scientific protocols and data may prove to be more amenable to verification than the vagaries of human behavior. We have made some nods toward recognizing “human factors” in science. Conflict of interest disclosures, for example, are now routine in journal publications. But while financial conflicts of interest can be documented and measured, psychological influences like motivation, jealousy, or pride remain qualitative and enigmatic.

Faith in the good intentions of our colleagues probably isn’t something we wish to lose. When scientists choose to act honestly, as they usually do, our traditions function just fine. A recent media firestorm over cell phones and brain cancer, however, reveals how simple it still is for an act of bad faith to baffle and even break the scientific system.

Tin foil hats on CNN

Last May, a colleague sent me an article on CNN about whether cell phones are causing a deadly brain cancer known as “glioblastoma.” The article was well-balanced. The limitations of epidemiologic studies were explained. Independent scientific experts were quoted. Readers were directed to respected government and non-profit agencies. CNN appropriately informed readers that “since cell phones emit low levels of radiofrequency energy that are non-ionizing, they’re not considered strong enough to permanently damage our biological tissues.”

It was the very existence of the article that concerned me. The CNN piece wasn’t an isolated report. A potential link between brain cancer and cell phones was picked up across the range of media, from tabloids to respected publications like USA Today. This wave of coverage was prompted by a study in The Journal of Environmental and Public Health, whose first author was Alasdair Philips. The study was a sober analysis of epidemiologic data purporting to show that the number of people developing glioblastoma multiforme (GBM) is on the rise.

A few parts of this story immediately felt off to me. First, this study was published in a journal run by Hindawi. Hindawi has faced controversy as experts have debated whether it qualifies as a “predatory” publisher that doesn’t abide by scientific standards. At the very least, The Journal of Environmental and Public Health would not be among the most prestigious publications in the field of public health.

The next thing I noticed was that the lead author was not affiliated with a university. I wondered how the author came to study this topic, so I performed a quick google search of his name. The results were enlightening. For more than a decade, Mr. Philips has been telling the media that electromagnetic radiation emanating from power lines, cell phones, and wireless internet routers are damaging our health – even causing cancer. He is part of an advocacy organization called Powerwatch and works for a for-profit company called EMFields, which sells equipment to “protect” people from such radiation.

I didn’t actually need to google the lead author to find this brief biography as he discloses these affiliations within the “conflicts of interest” section in his paper. Sadly, the CNN article didn’t address these conflicts in their reporting. Yet a conflict of interest statement hardly does this story justice. I found out, for example, that Mr. Philips has published articles on noted conspiracy theorist Joseph Mercola’s website, claiming power lines are causing childhood leukemia (a blood cancer). Worse, our houses are filled with potentially carcinogenic electronics – everything from stoves to hair dryers.

Mr. Philips claims that he personally suffers from “electromagnetic hypersensitivity”. This is Mr. Philip’s self-reported motive for his research:

[Electromagnetic radiation] gives me brain fog. I can’t think properly. I can’t concentrate properly. It gives me headaches. If I’m exposed at night it significantly disrupts my sleep. That was really when we started moving over and looking at those sort of devices.

In 2010, Mr. Philips wrote an article for the tabloid Daily Mail where he claimed that Wi-Fi is “frying our brains” and “electrosmog” causes everything from brain tumors to infertility. Mr. Philips wrote that to protect himself, he and his wife “have moved to a cottage in Scotland out of range of any mobile phone network.”

You can read plenty of unfounded information about “electromagnetic hypersensitivity” online, but authorities like the World Health Organization say that “well controlled and conducted double-blind studies have shown that symptoms were not correlated with [electromagnetic field] exposure,” and instead “these symptoms may be due to pre-existing psychiatric conditions as well as stress.” Journalist Joseph Stromberg has eloquently reported on how this disorder lives at the intersection of psychogenic illness, conspiracy theory, and mass hysteria.

An honest interpretation of this public data suggests Mr. Philips is a long-time “true believer” and activist. Back in 2007, Ben Goldacre even pointed out Philips once tried to sell an almost-literal “tinfoil hat” to protect people from electromagnetic waves. In short, this is not the kind of “expert” that should be interviewed on CNN without context.

Extrinsic evidence

Should Mr. Philip’s long-running personal media crusade affect how we view his scientific paper? After all, you won’t find any of these fringe ideas in the study itself. In the “possible causal factors” section of his paper on GBM, ionizing radiation from x-rays and CT scans are listed first, followed by the environmental effect of atomic bombs tests, increasing air pollution, and only last is cell phone use mentioned. Looking at the paper in isolation, the authors don’t appear too concerned.

The conclusion Mr. Philips has presented to the media is a different matter. Mr. Philips told CNN, “Cell phones seem like really they’re the most likely cause [of brain tumors].” In other interviews, Mr. Philips said, “We found the highest rise in incidence in frontal and temporal regions of the brain. This raises the suspicion that mobile and cordless phone use may be promoting gliomas.”

With knowledge of his years-long activism in this domain, this misleading interpretation of his own study comes as no surprise. When reviewing this paper, I don’t know if the journal googled the study’s authors like I did, or if they decided the work could stand on its own. The subsequent media panic that resulted from the study did catch the attention of the journal, which issued a response on its website. Surprisingly, the journal appeared to primarily place the blame on “rogue” organizations, when it is clear from the author’s own media interviews that he wanted people to arrive at the conclusion that cell phones are causing brain cancer.

The journal also asked Mr. Philips and his co-authors to issue a formal letter providing more scientific information on the matter. In their letter, they say the link between cell phones and brain cancer is “inconclusive” and another scientist has shown “the GBM [glioblastoma] rise was not associated with his mobile phone use impact modelling.”

In the legal world, there is the concept of “extrinsic evidence.” Judges may rarely take into account information that has not been presented in court but that is nevertheless relevant to understanding the situation. It seems necessary to utilize such evidence in this case. Mr. Philips has been circumspect in his academic writing compared to the claims he’s made in the mainstream media. I am apt to believe the media Alasdair Philips is more “real” than the character he plays in journals.

Some experts claim these ulterior motives have negatively influenced the quality of his science. The study, for example, chose to report on the rise in glioblastoma between 1995-2015, mirroring the rise in cell phone use, despite evidence that the rise in brain cancer incidence began much earlier.

Won’t get fooled again

To me, it is obvious Mr. Philips manipulated the journal and the media. Most people won’t look at the original scientific study when the media reports on it, so he uses a scientific publication as “cover” for his outlandish public claims. He can in turn go back to the journal and downplay these very same conclusions.

Journalists have an obligation to get “the whole story” in their reporting. Given how a simple google search revealed so much about the study’s lead author, CNN and other serious outlets should have performed this basic due diligence and incorporated it into their reporting.

Scientific editors, however, are not investigative reporters, and I don’t think it’s fair to ask them to perform background checks on all the authors who submit papers to their journals. There are also bigger scientific values at stake. How much “faith” should the scientific community have in the good intentions of its participants? Is an ulterior motive alone enough to issue a retraction? Scientists should not be put on trial, but just as I was asked why I wanted to be a doctor when I applied to medical school, our scientific institutions should be more willing to ask, “What are you trying to accomplish with this research in the first place?”

I would argue that in these extreme circumstances – an activist with a history of disseminating highly questionable medical information while simultaneously profiting from it – the journal should retract the study on account of convincing evidence that the author is using the credibility of the publication to spread medical misinformation. But the subjectivity of such an approach could easily be abused in more ambiguous cases. Even serious scientists have been known to take their conclusions one step beyond the evidence when giving media interviews.

All of us have a motive for our scientific or medical work. In our best moments, we transcend personal motivations to go where the evidence leads us. Yet scientific work does not stand on its own. To have influence, science must be discussed, contextualized, and promoted. Regardless of evidence, we ultimately must “believe” our colleagues, just as patients must “believe” their doctors. For now, the public still seems to have faith in physicians and scientists, but we can’t rest on our laurels. Politicized scientific fields like vaccines, evolution, and climate change show just how skeptical the public can get. If we don’t actively confront bad actors and bad science, public distrust could easily spread. I don’t want to risk having “fake medicine” or “fake science” become a cynical rallying cry alongside “fake news.”

Posted by Benjamin Mazer

Benjamin Mazer, MD is a resident in pathology at Yale-New Haven Hospital. His views are his own, and don’t represent those of his employer. You can reach out to him at @BenMazer on Twitter.