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What is scientific truth?

Truth is a seemingly simple concept. From childhood, all of us are admonished to ‘tell the truth’. When this follows a dispute and both sides ‘tell the truth’, we are reliant on the wisdom of an arbitrator (initially a parent) to decide whose version of the truth is true. To define truth seems simple, yet the study of truth has become a science of its own, epistemology. Truth can be altered by our own belief systems, our culture and our society. If we live in a desert where grass is always brown, why should we believe it true that grass is green? If a blind man believes that tomatoes are brown, who is it to argue against that personal ‘truth’. If we believe hormones are good for postmenopausal women, is it harder for us to believe they may cause harm? Post-modernist theory defines truth as a product of our own beliefs which act as filters to protect us from reality (if reality truly exists). Accordingly, it is impossible for anyone to declare an ‘absolute truth’ since our individual perception of that truth is affected by our own perceptions and beliefs. However, we all need some concept of truth to help us in our daily lives, and community agreement provides a solution. When a group of people agree on a ‘truth’, this agreement (whilst not a definition of truth) provides a means of forming a knowledge community with shared values. In science, what we refer to as truth is really a distillation of evidence. The quality of scientific truth is therefore dependent on the quality of the evidence, the quality of the research protocol, the quality and integrity of those carrying out the research and the vigilance and diligence of editors and peer reviewers. The world’s first scientific journal, Philosophical Transactions, was published in 1662 by the Royal Society of London. The goals of the editor, Henry Oldenburg, were to publish new research, encourage debate and eventually agreement and, in a very post-modernist way, to make money. It remains not just the first but also the longest continuously published scientific journal. Thus began the shared truth of scientific research. A hypothesis is developed, a trial conducted to test the hypothesis and the result submitted for publication. Others read the paper and conduct their own research to test the original claim. If they agree, they declare the original claim valid or ‘significant’ if it passes certain mathematical tests. This does not make the finding ‘true’; it may still be later disproved or found to be falsified. It just means that most of the scientific community have studied the theory and agreed it is true, based on their understanding at that time. In other words, they agree with the evidence. Scientific evidence is what guides us in our professional lives. Good scientific evidence takes time, effort, patience and money. The results must be objective and unbiased and, as pointed out in an earlier editorial in Climacteric, funding sources remain an important source of potential bias which we must consider. Data validity is also critical. Data must be collected ethically and safely and results reported for the entire study population and not necessarily extrapolated to other populations. When submitted to a journal, due process should be confirmed by the editor including confirmation by all authors that the paper accurately represents the research conducted and the results reported. This is followed by peer review, the last and most critical step before publication. It is the opinions of our peers which will determine if and where our research will be published and to what extent it will be cited by others. If the paper is of sufficient importance, an editorial may be commissioned. Too often this will be by someone linked to the authors whereas, to further strengthen the evidence, it should be by an independent person of the editor’s choosing. A very important and significant paper was published in July 2002 in The Journal of The American Medical Association, JAMA. Entitled ‘Risks and benefits of estrogen plus progestin in healthy postmenopausal women’, it was the first publication from the Women’s Health Initiative (WHI) randomized clinical trial. The results of this trial are well known. In contrast to the positive information gained from earlier observational studies, these data were suggestive of harm. The paper was released, as is commonly the case, at a press conference and in such a way as to make maximum impact. The media told the public that users of postmenopausal hormone replacement therapy were ‘29% more likely to suffer coronary heart disease, 26% more likely to contract breast cancer and 41% more likely to suffer a stroke’. That the absolute numbers were seven more cases of heart disease, eight more strokes and eight more breast cancers per 10 000 women was lost in translation.