Marcia Angell, "Science in the Courtroom: Opinions Without Evidence"

After graduating from Boston University School of Medicine and becoming a board-certified pathologist, Marcia Angell joined the editorial staff of the New England Journal of Medicine in 1979 and was promoted to Executive Editor in 1988 and interim Editor-in-Chief in 1999. Currently Senior Lecturer in the Department of Social Medicine at Harvard Medical School, Angell writes and speaks publicly on medical ethics, health policy, and the nature of medical evidence. In 1997, Time magazine named Marcia Angell one of the 25 most influential Americans.

Angell is the author of the critically-acclaimed Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case (1996), which explores the influence that "junk science" has in the court system and in the public sphere more generally. Arguing that the value of science resides in its commitment to assessing evidence objectively, Angell details the ways this commitment is undermined in the courts, where scientists are tempted to sell their expert opinions to the highest bidder.

Angell's more recent work explores how conflicts of interest in the scientific community are further undermining the unfettered pursuit of truth. As Angell sees it, it is the responsibility of scientific journals like the New England Journal of Medicine and of academic medical centers to conduct objective research projects and to subject the results of such projects to rigorous and unbiased analysis. Fulfilling this responsibility has become increasingly difficult, Angell believes, precisely because the doctors, scientists, and technicians who carry out this research rely on medical and pharmaceutical corporations to fund their work. This is a problem because:

the mission of investor-owned companies is quite different from the mission of academic medical centers. The primary purpose of the former is to increase the value of their shareholders' stock, which they do by securing patents and marketing their products. Their purpose is not to educate, nor even to carry out research, except secondarily or as a means to their primary end. I believe academics often forget this, and allow themselves to believe that marketing is really education.

In Science in the Courtroom: Opinions Without Evidence, we find Angell asking a similar set of questions: What ethical standards should scientists be held to? What role should science have in a civil society? And is it possible to preserve science's commitment to service and disinterestedness once scientists move out of the laboratory and into the courtroom and the marketplace?

Angell, Marcia. "Science in the Courtroom: Opinions Without Evidence," Science on Trial : The Clash of Medical Evidence and the Law in the Breast Implant Case (W.W. Norton & Company, 1997). 111-132.
Digital image drawn from the PBS web site.
Quotation taken from Angell's remarks at the Health and Human Services Conference on Financial Conflicts of Interest on August 16, 2000, in Bethesda, Maryland..

Links to Explore:

Justice is Good for Our Health: an article by Norman Daniels, Bruce Kennedy, Ichiro Kawachi that argues that economic inequality undermines public health; Marcia Angell's "Pockets of Poverty" analyzes the assumptions behind this argument.

The Breast Implant Controversy: web site maintained by Marmoset Media, which seeks to help "consumers understand how to 'decode' medical claims in order to make the best decisions for their own health care needs." Includes links to Dow Chemical, the Coalition of Silicone Survivors, and informational sites about Nir Kossovsky and Marc Lappe.

The Centers for Disease Control and Prevention: this site, maintained by the government's lead federal agency for protecting the health and safety of people, provides access to the kinds of epidemiological data Angell most values, as well as official responses to medical hoaxes and rumors.

HG Experts.com: homepage for a service that provides referrels to experts to "the right expert, consultant, mediator, expert witness or medical specialist."

Questions for Learning:

• In Marcia Angell's response to Justice is Good for Our Health, we see her evaluating the assumptions, arguments, and evidence that Daniels, Kennedy, and Kawachi have presented. How does this kind of exchange, which takes place in print between experts, differ from the ways that lawyers, judges, and juries assess evidence, as described in "Science in the Courtroom"? What kinds of evidence does Angell call on to make her argument in "Pockets of Poverty"?
  
  
• While Marcia Angell's argument in Science on Trial is that there is no credible scientific evidence establishing a causal link between breast implants and connective tissue disease, sites like The Breast Implant Controversy make it clear that Angell has not had the last word in this matter. Why hasn't Angell's evidence put an end to the matter? How would she respond to the counter-arguments that are made on this site?
  
  
• The Centers for Disease Control and Prevention are responsible for monitoring the health and the safety of the nation which they do, in part, by collecting and analyzing statistics about the mortality and injury rates of the nation's citizens. This is the sort of data that most interests Angell, for it points to trends and patterns. Visit the data and statistics page and explore the area that most interests you. How might the CDC data be used in court? Can such data be compelling evidence to a layperson?
  
  
• HG Experts.com provides a valuable service, but is it the kind of service would receive Angell's approval? As you explore the site, what do you learn about the directory's ways of determining who is an expert? What is the difference between hiring someone as a consultant and hiring someone as an expert witness? Would it make sense to create a similar website that provided access to "expert jurors"?
  

Questions for Connecting:

• In "The Ganges' Next Life," Alexander Stille focuses on Veer Bhadra Mishra's collaboration with William Oswald to use sustainable technology to clean up India's holy river. Stille is intrigued by Mishra's "complex double identity" and spends much of his piece trying to make sense of how Mishra can be both a devout Hindu and a scientist at the same time. What is a "complex double identity," exactly? Does everyone have one? Does Marcia Angell have one? What would you say is the relationship between the identity one chooses and the evidence one values?

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