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Pioneer Award Address: Ignorance isn’t biased: Comments on receiving the Pioneer Award

April 1, 2009|Cleveland Clinic Journal of Medicine
David S. Goldstein, MD, PhD
Author and Disclosure Information

David S. Goldstein, MD, PhD
Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

Correspondence: David S. Goldstein, MD, PhD, Building 10, Room 6N252, 10 Center Drive, MSC-1620, Bethesda, MD 20892-1620; goldsteind@ninds.nih.gov

Dr. Goldstein reported that he has no financial interests or relationships that pose a potential conflict of interest with this article.

ABSTRACT

Researchers ordinarily work by deriving testable hypotheses from theories using a deductive process. Hypothesis testing is inherently biased, however, because of the practical requirements of finding and publishing positive results. In contrast, ignorance isn’t biased. The combination of relevant new technology, sufficient mastery of the topic to know what is not yet known, and access to patients with rare but informative disorders sets the stage for discoveries about disease mechanisms based on induction from observations. Patient-oriented research is a strength of heart-brain medicine. Patients are a unique scientific resource because they tell us the truth. We experience the joy and thrill of a “sparkle of insight” when we realize what they teach.

SUMMARY AND CONCLUSIONS

Because ignorance isn’t biased, if you have the tools to make relevant measurements, if you have sufficient mastery of the subject to know what isn’t known, and if you have access to patients with rare but informative disorders, you can make important discoveries based on inductions from observations.

The discoveries that cardiac sympathetic denervation characterizes PD and that parkinsonism does not result from loss of dopamine neurons per se depended crucially on studying patients with a rare disease, PAF. In 1657, William Harvey—the same William Harvey who first described the circulation of the blood and who first pointed out the effects of emotions on the heart—wrote eloquently about the extraordinary power of studying patients with rare diseases:Nature is nowhere accustomed more openly to display her secret mysteries than in cases where she shows traces of her workings apart from the beaten path; nor is there any better way to advance the proper practice of medicine than to give our minds to the discovery of the usual law of nature, by the careful investigation of cases of rarer forms of disease. For it has been found in almost all things, that what they contain of use or of application, is hardly perceived unless we are deprived of them, or they become deranged in some way.21

I hope I have convinced you of the importance of seeing what isn’t there. My thanks go out again to the Earl and Doris Bakken Heart-Brain Institute for this prestigious award, to my family, to my colleagues and friends, and to my patients. As I have written in Adrenaline and the Inner World: An Introduction to Scientific Integrative Medicine,17 patients serve as a unique scientific resource. They report what is wrong; they tell us the truth. We have to make sense of what they teach.

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