Medical Research is About What Happens, Not Why

The life expectancy of people in countries like Canada has risen remarkably over the last 100 years, from 47 to about 80. Not only are people living longer. They are having more productive and healthier lives than ever before. Much of this gain has been due to medical research that shows what happens to people in response to changes in the environment, sanitation, vaccination, surgical therapies, diet, physical activity, and drugs. The benefits of this research were experienced by the general population as well as by people with all types of diabetes. The most famous example is the life expectancy of someone with type 1 diabetes. In 1920, it was about 1 year, and in 2020, it was almost the same as that of the general population. Another example is the remarkable decrease in blindness and amputations experienced by people with diabetes of all types over the last 50 years.

Medical research delivers these benefits through a well-established process. This includes making careful observations on a well-defined group of people, introducing and/or measuring some change experienced by these individuals (such as the introduction of a new drug or surgical technique or diet) and then repeating the measurement on one or more occasions. This approach can be applied to either individuals or to society. When this approach is repeated more than once, and every time it is done, the same results are observed, it proves that the therapy or exposure or intervention is responsible for the effect. It can then be used to justify treatment policies and guidelines for care.

This cycle of observing, intervening and/or measuring, and observing again (and again) represents the core of medical research. Carefully made observations that lead to the same results every time they are made is the best proof that science can provide. For example, in 1922, after a a person with type 1 diabetes received the first ever injection of insulin, it turned him from a frail and sick individual to one who was robust and healthy. The first time may have been a fluke. But after the same results were seen every time, it became clear that insulin was clearly a game-changer for people with type 1 diabetes.

Note that the above discussion contains nothing about mechanisms or why something worked. Medical research and science are about what happens. Explanations for the “why” are how scientists tie their observations together in a way that makes sense based on their current understanding of biology. But what makes sense today, based on today’s understanding of biology, may not make sense tomorrow. The understanding of biology changes all the time and the explanations for why things work change along with it.

The bottom line is that when someone or some article claims that something is an effective therapy, they need to provide evidence of repeated observations to support their claim. If someone or some article claims that some therapy works based on a clever-sounding explanation of why it should work, the important question to ask is “but where are the observations proving that it does work?”.

Medical research and science in general are all about showing the “what”. The “why” comes after the fact.

About the author

Hertzel Gerstein

Hertzel is an endocrinologist and professor at McMaster University who is in high demand as a speaker, advocate, and educator on diabetes-related topics. His research focuses on using large, international randomized trials to identify and test new ways of preventing type 2 diabetes, reducing serious health outcomes like strokes and death, and achieving type 2 diabetes remissions.