Take a plane, not a drug
April 4th 2008, 13:26 | Bryan Hubbard
Do you think that the science that determines the safety of the drugs we take is the same as the science that determines the safety of aircraft technology?
It's a question that lies at the heart of a fascinating paper from Herman Jeggels, a medically-qualified doctor who now practises in his native South Africa. In it, he compares the science employed by NASA, the American Department of Defense and the UK's Ministry of Defence, with that of medicine.
Since the 1980s, NASA has used technology readiness levels (TRLs) to eliminate risk and determine the maturity and safety of their technologies, and which has been taken up by the two ministries of defence. NASA seeks a zero risk on all its technologies, and would consider as unacceptable even a 3% risk of an aircraft or satellite crashing in a residential area.
To achieve this level of safety, the technology must pass through nine stages, which embrace the science (TRL 1-2), experimentation (TRL 2-3), verification (TRL 4-7), and demonstration (TRL 8-9).
By comparison, medicine never gets beyond TRL 3 - the level of high-risk experimental technology - in asessing the safety of its drugs. At level 3, the technology - or pharmaceutical - would still have an immature, uncertain and high-risk status. A randomised controlled trial on a drug is an experiment, producing experimental evidence only.
"Therefore," writes Jeggels, "therapies marketed on the basis of randomised, controlled trials represent unverified, untested, immature, high-risk therapies, resulting either in the suffering or death of patients, and certainly do not reverse most disorders."
So now you have an intelligent answer ready the next time somebody tells you that medicine is 'scientific'.