Convocation Address at McMaster: Evidence-Based Medicine, Predictability and Unpredictability

Abstract

Madam Chancellor, President Farrar, Honored Guests, Graduands, Family, and Friends:

It is a great honor and unique pleasure to receive this doctorate from McMaster University and to give this Convocation Address. McMaster is a leading world-class institution. This is the place where evidence-based medicine was born, where its principles matured and where its impressive applications keep growing. The advent of evidence-based medicine represents a momentous turning point in the history of health sciences and health care. I come today as a pilgrim to your institution thankful for everything I have learned from you over the years. I hope to continue to learn from your brilliant achievements for years to come.

I congratulate all of you who graduated today. I am delighted to share your joy and applaud your accomplishments. You and your family and friends must be very proud. May your paths in the future provide abundant opportunities for more celebration and joy, for exciting stimulation and a sense of fulfilment.

While I wish you success in all your endeavors, this is not enough. My valediction needs to be coupled with a second wish: May you have wisdom, resilience, and ingenuity to benefit also from whatever disappointments, obstacles, and frustrations you may encounter. Setbacks and failures can be wonderful. I admire people who can become grand masters at the art of failing. Personally, I am grateful for my numerous failures and defeats, for all the calamities I have encountered. I consider myself fortunate whenever I realize even more deeply how little I know, how uninformed or misinformed I have been, how miserably I have failed. Then I have a reason to wake up the next day and do better. Well, perhaps one day I may wake up and think that everything is perfect. If that perfection ever happens, I suspect I will be hallucinating, lobotomized, or clinically dead.

None of us knows for sure what the next day will be like. I do like to plan, even meticulously so. I try to think in advance, using the best available evidence. I indulge in making far-reaching plans and outlines for research, for projects or for my life. As a meta-researcher focused on research methodology, I am sort of a maniac about fleshing out protocols and methods sections in painful detail. But I am always fascinated by my recurrent inability to predict and by how often these over-ambitious plans require revisions or simply fall apart. Science, medicine, health and life at large can be so stunningly surprising.

We live in an era of tremendous predictive power, or so we are told by experts, decision makers, artificial intelligence gurus, and many other pundits. Both experts and non-experts proclaim predictions all the time. While it is precarious to extrapolate any regression beyond the already observed values, we do this routinely, nonetheless. The voices that are heard the loudest are not necessarily the ones that use the best predictive methods. W.B. Yeats remains as relevant today as when he wrote his famous poem a century ago right after the 1918 pandemic when an old world was coming to an end: The best lack all conviction while the worst are full of passionate intensity. While we are flooded with predictions, we also face tremendous predictive inability when it comes to issues that matter the most. How will science, medicine, health, life at large, our world be like in 10, 20, 40 years from now? Do we really have any serious clue? For example: Will we still have physicians and healthcare workers, or would we all be replaced by some intelligent software? Will humans still toil in science, posing research questions? Will our disease burden be smaller or greater? Will this beautiful and tormented earth still sustain life and human civilization as we know it?

We need evidence to try to answer a stream of burning, existential-level questions. And we also need humility to recognize our limits. While evidence-based approaches have grown stronger, the arrogance of experts and the insolence of non-experts have also become more influential. In dealing with powerful self-interested stakeholders, science and health are sometimes squeezed, distorted, and threatened with the worst outcomes. Sometimes I laugh when I recognize several strange bedfellows who court science. It is a bit like Nick Bottom with his donkey head flirting with the bewitched Titania in Shakespeare's Midsummer Night's Dream. The most beautiful fairy queen falls in love at first sight with what is the funniest, perhaps most ridiculous creature. The way that many politicians, Big Tobacco, Big Food, Big Pharma, Big Tech, big anything, as well as influencers, both mainstream and fringe media, frantic social media, and all sorts of impossible conspiracy dealers deal with science is often indeed a joke. Yet sometimes I also have dark thoughts on seeing that this joking dream may become even a lasting, worsening nightmare.

We have developed endless means to destroy ourselves. Caught between war, poverty, pandemics, injustice, corruption, authoritarianism, environmental degradation and climate change, further missteps can cost us dearly. However, we have also ample ways to collect and critically and impartially assess evidence, to learn, to improve ourselves, to help other human beings and to care sincerely for them, to remain free, daring and inquisitive, to love, to create. I am neither a pessimist nor an optimist. I think we should acknowledge unpredictability and make the most of it. To do this we may need fewer overconfident experts and more judicious evidence, less technological arrogance and more human compassion, less partisanship and more open-mindedness, less rush to speak and more eagerness to listen, less personal ambition and more willingness to serve, especially those who are sick, poor, disadvantaged, and marginalized.

The future is indeed unknown, but this uncertainty may be a blessing in disguise. The future is indeed unknown, but it belongs to you. Don't compromise and don't betray your dreams to do good. I trust that each one of you can change the world in ways that matter. Godspeed.

The text is the Convocation Address delivered at McMaster University for the graduating class of fall 2024 in the occasion of being awarded a doctorate honoris causa (21 November 2024). The ceremony is at: https://www.youtube.com/watch?v=wgE209h61Xs.

The author declares no conflicts of interest.