There’s a great article in Bari Weiss’ The Free Press that has great bearing on why consensus in science is often a bad thing, and how the consensus is enforced.

Called The Reason There’s Been No Cure for Alzheimer’s, it was written by Joanne Silberner, a former NPR reporter. What I loved about the article was its insightful reporting about how the scientific process works in practice, rather than how it should in theory. Most people have little idea how academic science works, what the incentives are, how peer review works, how money gets distributed, and all the minutia that determines the path that scientific research takes. Silberner captures the intricacies of the process well.

In 2019, the celebrated science writer Sharon Begley wrote a startling investigative story for the health and medicine publication STAT about why Alzheimer’s research was mired in decades of failure. She asserted this wasn’t just due to the complexity of the brain or the infernal nature of Alzheimer’s itself. There was another reason that had less to do with the nature of the disease, and more to do with the nature of research.

As she wrote:

“The most influential researchers have long believed so dogmatically in one theory of Alzheimer’s that they systematically thwarted alternative approaches. Several scientists described those who controlled the Alzheimer’s agenda as ‘a cabal.’ In more than two dozen interviews, scientists whose ideas fell outside the dogma recounted how, for decades, believers in the dominant hypothesis suppressed research on alternative ideas…This stifling of competing ideas, say a growing number of scholars, is a big reason why there is no treatment for Alzheimer’s.”

Now Silberner rightly (or mostly so) dismisses the idea that there is a “cabal,” in the sense that there is a conspiracy to stifle the scientific process per se. Rather, there is something akin to a “cabal,” in the sense that a very powerful group of scientists who firmly believe in their own theory who steer resources and prestige to people who agree with them. This, in turn, has kept research on a particular path and has stifled the search for alternative explanations for the symptoms of Alzheimer’s Disease, and alternatives for treating the disease.

The particular details of the theory don’t matter for my purposes, although I have personally followed the controversies because that is the sort of thing I do. It has always been striking to me that almost all the research and drug development money has been directed at treating one particular protein expression in the brains of most Alzheimer’s patients, and that every drug that has been developed has been close to useless. AARP did a long story about the use and abuse of dementia drugs, concluding that in the main they are useless and dangerous.

About 20 drugs have been developed to address dementia, and none of them do much except cost money and have side effects. None of them even claim to do much, except produce minor delays in the progression of disease.

If decades of research and drug development has been a failure, why hasn’t there been any major change in Alzheimer’s research?

It has to do with the process of scientific research, not necessarily any problem with either the scientific method or even the greed of pharmaceutical companies. A drug that cured or halted the progression of the disease would be wildly profitable.

One way to understand the persistence of the amyloid theory is to look at the incentives of big academic medicine, big governmental medicine, and big pharma. For decades, time, effort, and money have been sunk into this single hypothesis. If we just make the right intervention in the process of amyloid being deposited in the brain, the logic goes, Alzheimer’s can be beaten.

Acknowledging that this theory may be a dead end would mean entire careers and billions of dollars have all been devoted to the wrong idea. Not only that—there is no clear path to the right one.

Dr. Dennis Selkoe, Professor of Neurologic Diseases at Harvard Medical School, is among the most prominent supporters of the amyloid hypothesis. He’s not happy about accusations of a cabal. “It’s my opinion that there was never any kind of organized or even semi-organized or concerted effort to delegate any aspect of Alzheimer’s research to an inferior position and heighten amyloid studies,” he told me. “Like everything in science and the world, it was a competition of ideas.” He says some of his own amyloid grants have been rejected, and journals have turned down some of his papers. “That’s just part of academic research.”

For many years the powers-that-be within the neuroscience community—researchers who sit on the committees that determine who gets financial support from the government and research organizations, and who review research papers for medical journals to determine what should be published—supported the amyloid hypothesis to the virtual exclusion of any others. As Sharon Begley described it, amyloid proponents “influenced what studies got published in top journals, which scientists got funded, who got tenure, and who got speaking slots at reputation-buffing scientific conferences.”

All it takes is one member of a granting committee (typically, they have a dozen members) or one of the usual three or so reviewers of a research article to kill a project. Cabal or not—and while I think there’s groupthink going on, I don’t think amyloid proponents are engaging in a “conspiracy” —the frustration of the suppressed scientists was and is palpable, and has sent some talented researchers to other fields.

As Dr Selkoe asserts, how the money and prestige is distributed is just part of how academic research works. That is true enough, and it doesn’t require an organized conspiracy for some research paths to get enormous preference and others to get sent to the circular file. All you need is a consensus among decision makers that one path is the way to go. Everything else follows from that.

Consensus is the problem, not the result of proven success. It can impede success, should the people in power be simply wrong in their judgments. Happens all the time.

Max Planck, one of the great scientists of the 20th century, put this phenomenon succinctly: “A great scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.“

This, of course, is a slight exaggeration. Albert Einstein certainly had a huge impact and changed science forever, and he did it from a low-prestige position at the Swiss patent office. But of course being in the Swiss patent office he had no academic masters or funders to please. In today’s academic environment, he would have had a much more difficult time breaking through the clutter.

People unfamiliar with the academic sciences underestimate the obstacles to doing good science in such an environment. Researches depend upon grants, peer review processes, dissertation, hiring and tenure committees…. The lone genius scientist working in obscurity and generating a groundbreaking new theory is just not realistic.

Ironically, some of the greatest researchers of the 2nd half of the 20th century worked outside of academia. Bell Labs and Xerox Parc produced some great science once upon a time, because these incredibly profitable businesses funded basic research with fewer strings attached than is usually the case in academia. I remember meeting Arno Penzias, who won the Nobel Prize for work he did at Bell Labs, discovering basic evidence for the Big Bang theory. (My parents were astrophysicists).

As we have all seen during the COVID era, consensus in science can be as big a barrier to clear thinking and scientific discussion as outright censorship. The public health community rallied around an idea and sidelined anybody who dissented. It went to great extremes that are unusual in science, but the process is similar.

Science is a human enterprise, and like all human enterprises it really isn’t objective and abstract, as much as the best scientists try to make it so. In fact, some of the most creative scientists are also the least tolerant of other ideas. Big ideas and big egos go together often enough.

So keep all this in mind as you listen to scientists discuss their ideas, knowing that the process by which theories arise is complicated and messy. That doesn’t mean that science is corrupt. It means it is human.