The other day, my daughter, who was
once trained as a philosopher, explained performative utterances
to me. They are statements that, by the very act of carrying
them out, become true. If you want a trivial example, read
out loud the phrase: ‘I am speaking at this moment.’ Performative
utterances can be more serious. The priest who pronounces
that a man and a woman are now married, changes the status
of that man and woman just by the words he speaks. A celebrity
who, just before she swings the ritual bottle of champagne,
says ‘I name this ship Titanic’ has indeed
done just that.
The opposite of performative utterances,
performative contradictions, also exists. They are statements
that contain their own refutations. A man who says ‘I
cannot speak’ is
a straight forward example. Often, they are more subtle.
I remember Tony Blair, the prime minister of the UK, saying
that ‘he was genuinely sorry’ when one of his
cabinet ministers had resigned. If he had not used the
word ‘genuinely’, I would have had no difficulty
in believing him. As it was, that extra unnecessary word
made one doubt the sincerity of the sentiment he was expressing.
Doctors do not often get to make performative utterances.
Saying that you think a patient is going to recover does
not ensure his survival even if the patient’s relatives
sometimes believe that it does. But although our statements
do not become true simply by the act of saying them, we
are in the enviable position of being members of a profession
with a reputation for truthfulness. The same cannot be
said for politicians or lawyers. And, in my experience,
the reputation is deserved. There is a professional culture
of truth telling in medicine and doctors do not, for the
most part, lie to their patients or their colleagues.
There was a time when scientists had a similar reputation.
But nowadays, at least in some countries, there is a view
that scientists cannot be trusted to give honest and straightforward
accounts of what they do and that they need to be policed.
The USA, for example, has an office of research integrity
and the UK has been strongly criticized for not having
something similar. The possibility of scientific fraud
bothers editors of journals too. The Journal of Clinical
Investigation, a high impact factor, open access journal,
recently published an editorial entitled ‘Stop misbehaving’.
You can read it at http://www.jci.org/cgi/content/full/116/7/1740.
It was written by the executive editor following the receipt
of manuscripts where Adobe Photoshop had been used to improve
the appearance of the western blots. Apparently, this software
makes it easy to clean up the background, erase duplicate
bands and construct a composite image by cutting and pasting.
What surprised me about the editorial, however, was its
author’s conviction that, despite the amount of time
she spends dealing with misconduct, researchers are, by
and large, an honest bunch. She believes that it is just
a few rotten eggs who are causing the
trouble. Perhaps she is right and there is a sharp distinction between a tiny
minority of researchers prepared to commit fraud and the
rest of the scientific community whose behaviour is invariably
exemplary. But I’m doubtful. Isn’t it more
likely that these cases are the tip of an iceberg?
Geoffrey Rose, a cardiovascular epidemiologist, is remembered for his explanation
of how an individual’s risk of disease depends crucially on the way in
which the population at large is exposed to the causes of that disease. Where
levels of exposure follow a continuous distribution, which for the most part
they do, the number of people at high risk is powerfully determined by the average
level of exposure for the whole population. So the prevalence of hypertension
can be predicted from the average blood pressure in the community; or the prevalence
of alcohol dependence by how many drinks the average person consumes each week.
Rose even reckoned that the amount of violent crime in a society was influenced
by the amount of aggression that the average person displays, or is prepared
to tolerate, as he or she goes about their everyday business.
If we apply the idea to the reporting of biomedical research,
we need to look at our own behaviour as doctors and researchers and examine what
we are prepared
to let pass in the behaviour of our colleagues and collaborators. These are the
things, if Rose was right, that set a standard that determines the quantity of
more extreme forms of dishonesty. And the corollary is that if we want
to reduce scientific misconduct, we would do better not to emulate the USA and
set up an office of research integrity to investigate the extreme cases, but
to make sure that the way in which we report our own research
is beyond reproach.
I’ve worked in the editorial offices of two biomedical journals and I guess
that I’ve read several thousand manuscripts submitted for publication.
Out of these there have been a handful of cases of fabrication, falsification
or plagiarism. But I’ve encountered hundreds of lesser examples of dishonesty.
The sort of thing I mean is the retrospective case-series presented as a prospective
investigation; the cross-sectional survey labelled as a cohort study; tabulation
of percentages when the total number of people studied is less than a hundred;
controls glibly described as matched when, in fact, they were selected haphazardly
from colleagues in the laboratory. It is often hard to know whether these should
be classified as deliberate efforts to mislead, naïve attempts to give poor
methods undeserved credibility or just slipshod work.
You may think that this sort of thing does not matter much: that a critical reader
would not be fooled. Rose, I believe, would have disagreed. Surely he would have
reminded us that if we tolerate minor misdemeanours in the many, a few will get
away with murder. Papers in biomedical journals can never have the self-validating
status of the performative utterance. But isn’t that the direction in which
we ought to be heading?